Aortic
atheroma, involving the ascending aorta and proximal aortic arch, is associated with an increased risk of cerebral and peripheral embolic complications and cardiovascular complications (acute
myocardial infarction, vascular death, peripheral arterial ischaemia). These data were established on prospective, case-control, anatomical studies, which all used transoesophageal echocardiography as the reference diagnostic method. In the absence of an alternative radiological imaging technique, transoesophageal echocardiography describes the thickness of the plaque, its
luminal extension, its more or less regular nature, and the presence of plaque calcifications and sessile or mobile thrombi. Some predisposing factors are associated with the thromboembolic risk of aortic athero-
sclerosis: elevated plasma
fibrinogen, presence of
circulating anticoagulants, elevated plasma
homocysteine. The mana-gement of these patients is purely empirical at the present time. Antiplatelet treatment is formally indicated following
cerebral infarction. The presence of
thrombosis on the
atherosclerotic plaque constitutes an indication for
anticoagulant therapy. The indication for thrombolysis and surgical resection of the aortic
atheroma is anecdotal, in the absence of proof of their efficacy on large series. Progress in radiological and echocardiographic imaging, and complementary epidemiological studies should be able to more clearly define patient subgroups at higher risk. Aortic
atherothrombosis was also recently associated with increased cardiovascular complications in patients with
atrial fibrillation (
SPAF III trial).