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New imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), transoesophageal echocardiography (TOE), and intravascular ultrasound (IVUS) have improved the detection of diseases of the aorta. These techniques not only provide a better visualisation of the aorta but also a better understanding of the pathogenesis of aortic diseases, which have led to new strategies for decision making and patient management.
Arteriosclerosis of the aorta
Arteriosclerosis of the aortic wall begins with the development fatty streaks, with intermediate lesions being found in children and young adults. In necropsy studies up to 15% of the latter group have been found to have advanced lesions such as atheroma and fibroatheroma. Early intracellular and extracellular calcification develops in intermediate lesions and atheroma. Complicated lesions are characterised by plaque erosion or rupture forming plaque ulcers, mural thrombus formation, and intramural haemorrhage/haematoma.
The development of arteriosclerosis of the aorta is related to traditional risk factors—hypertension, hypercholesterolaemia, and smoking.1 In addition, fibrinogenaemia and homocysteinaemia are related to the development of aortic sclerosis. Not surprisingly, aortic arteriosclerosis is a marker of coronary artery disease. High sensitivity and positive predictive accuracy have been found for presence of significant coronary artery stenosis in patients in whom TOE could demonstrate atheroma of the aortic wall. A grading from I to V (table 1) has been developed which is related to the risk of embolisation and the development of strokes.
A significant relation between plaque morphology and the risk of stroke has been found. The risk is high in patients with signs of lipid pools, calcification, and plaque thickness of more than 4 mm, but plaque ulceration by itself was not found to increase embolic risk. Thus, the detection of plaques at risk (vulnerable plaques) seems to be important.1 The prevalence of atheromas in the aortic arch was 20–30% …
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