Mobile atheroma of the aortic arch is an underestimated source of embolization

BACKGROUND: Mobile atheroma are associated with increased perioperative strokes in patients undergoing coronary artery bypass surgery. Peripheral embolization is an additional risk. Transesophageal echocardiography (TEE) accurately identifies mobile atheroma. Recent reports have discussed the possible influence of anticoagulant therapy in promoting peripheral cholesterol embolization. METHODS: Fourteen patients with mobile atheroma were treated with anticoagulation. A review of literature reporting results and complications of anticoagulation in the treatment of this condition was compared with our recent experience. RESULTS: Between 1994 and 1996, 14 patients with peripheral embolization and mobile atheroma confirmed by TEE were anticoagulated. Clinical follow-up between 6 to 30 months has demonstrated no further evidence of systemic embolization since anticoagulation. Furthermore, repeat TEE in 3 of 14 patients no longer visualized mobile atheroma. CONCLUSIONS: Mobile atheroma are recognized sources for embolization. Patients with generalized atherosclerosis should be screened for this condition in cases of systemic embolization. Anticoagulation may have therapeutic considerations in the management of this condition.