The mobile thrombus in the aortic arch is a rare condition, which becomes rarer when associated with cerebral infarction, resulting in disabling complications. Transesophageal echocardiography is useful for detecting the source of thrombi in the heart and aortic arch. Here, we report a case of a patient who suffered from recurrent cerebral infarction four times during the previous 18 months due to mobile thrombus in the aortic arch despite anticoagulant therapy. The thrombus with rocking motion (9.6 and 8 mm) was laid in the top of the aortic arch, and surgical resection was not allowed due to the location. We began anticoagulation therapy initially with heparin followed by a combination of warfarin, aspirin, and atorvastatin with an international normalized ratio between 2 and 3. The size of the aortic thrombi was significantly decreased by 3 mm and stabilized after 18 months.

Citations

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• The Efficacy of Medical Interventions for Free-Floating Thrombus in Cerebrovascular Events: A Systematic Review
  Fairoz Jayyusi, Majd M. AlBarakat, Habib H. Al-Rousan, Mohmmad M. Alawajneh, Abdel Rahman Alkasabrah, Mo’tasem Abujaber, Mohammed E. Aldabbas, Mustafa Abuelsamen, Yahya Alshgerat, Yahia Sayuri, Nazeeh Alhertani, Mohammad BaniAmer, Issa Shari, James Robert
  Brain Sciences.2024; 14(8): 801.     CrossRef
• Cerebral Infarction Due to Aortic Mural Thrombus in a Non-atherosclerotic Ascending Aorta, Detected by Cardiac CT
  Ryuichi NODA, Yuta TAMAI, Masato INOUE, Tetsuo HARA
  NMC Case Report Journal.2021; 8(1): 325.     CrossRef
• Aortogenic cerebral embolism treated by ascending aorta replacement in an 80-year-old male
  Masanori Nakajima, Haruko Okano, Tomohisa Denbo, Teruyuki Hirano, Atsuro Chiba, Hidehito Endo, Hiroshi Kubota, Anna Isomura, Hiroaki Shimoyamada, Yasuo Ohkura, Yoshiaki Shiokawa
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Objective: Among risk factors associated with cerebral infarction, cardiac factors are well known to be very important. However there were only few studies related to correlation between cardiac risk factors and stroke recurrence. So we tried to evaluate cardiac disease as a risk factor of recurrent cerebral infarction.

Method: Subjects were 118 patients (62 male, 56 female) with cerebral infarction and were divided into first attack group as a control and recurred group. We evaluated the results of transesophageal echocardiographic study and other major risk factors and the results were compared in two groups using Χ² test.

Results: Control group was 75 patients (39 male, 36 female), and recurred group was 43 patients (23 male, 20 female) and the mean ages were 62.8 years and 66.7 years, respectively. General transesophageal echocardiographic abnormalities were shown in 63 cases (84%) in control group and 40 cases (93%) in recurred group. Among the abnormal transesophageal echocardiographic findings, atherosclerosis of aorta was significantly higher in recurred group (49%) compared to control group (25%) (p＜0.05), but there were no significant difference in aortic valve calcification, mitral calcification etc. Among the major risk factors of cerebral infarction, hypertension, diabetes, hyperlipidemia, and alcohol intake showed tendency of high incidence in the recurred group. Patients with abnormal EKG findings concurrent with abnormal transesophageal echocardiographic findings showed in 33 cases (44%) in control group, and 24 cases (56%) in recurred group, but there's no statistical significance.

Conclusion: Our results do not support the hypothesis that TEE would be able to diagnose the cardiac risk factor for recurred cerebral infarction. However, the prevalence of atherosclerosis of aorta was significantly higher in recurrent group, so further studies would be needed.