The atherosclerotic aortic arch: considerations in diagnostic imaging.

The atheromatous aortic arch poses a diagnostic and therapeutic challenge to the clinician. The association between aortic atheroma and clinical events such as stroke and distal embolization have been well described in the literature, but the best approach to assessment of risk is controversial and evolving. This review seeks to highlight the significance of factors such as aortic plaque morphology, distribution, and severity. The different imaging modalities currently available for evaluating aortic plaque (including transesophageal echocardiography, non-contrast- and contrast-enhanced computed tomography, positron emission computed tomography, magnetic resonance imaging, and intraoperative epiaortic ultrasonography are compared and contrasted.