Ay et al classified cardioaortic sources of cerebral embolism. These sources may also cause emboli elsewhere in the body. The authors are from Massachusetts General Hospital, Harvard Medical School, UCLA Medical Center, Columbia University and NINDS (of NIH).


High risk sources:

(1) thrombi in left atrium and/or left ventricle

(2) recent myocardial infarction

(3) atrial fibrillation, including paroxysmal atrial fibrillation

(4) atrial flutter

(5) sick sinus syndrome

(6) rheumatic valve disease of mitral and/or aortic valves

(7) mechanical or bioprosthetic heart valve

(8) infective endocarditis

(9) nonbacterial thrombotic endocarditis

(10) papillary fibroelastoma

(11) left atrial myxoma

(12) nonischemic dilated cardiomyopathy

(13) congestive heart failure with low ejection fraction (< 30%)

(14) ischemic cardiomyopathy with low ejection fraction (< 28%)


Sources of low or uncertain risk:

(1) mitral annular calcifications

(2) patent foramen ovale

(3) atrial septal aneurysm with or without patent foramen ovale

(4) left ventricular aneurysm without thrombus

(5) complex atheroma in the ascending aorta or proximal arch

(6) third-degree atrioventricular block and other cardiac arrhythmias



• Passing an intra-arterial catheter across a complex atheroma in the aorta would make it a high risk source of emboli.


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