Aortic arch plaque in stroke.

Patients with severe aortic arch plaque are at high risk for stroke. This article addresses the complex nature of the association between aortic arch plaque and stroke. The aortic arch plaque poses a diagnostic and therapeutic challenge to the clinician. The different imaging modalities currently available for evaluating aortic plaque are discussed. Therapy to prevent emboli from aortic plaque is not yet established. Retrospective data in patients with severe aortic plaque support using oral anticoagulation and statins to prevent stroke. Iatrogenic embolization can occur as a result of aortic manipulation during invasive vascular procedures or cardiovascular surgery. The risks and benefits of these procedures must be carefully weighed, and alternate approaches should be considered for patients with severe aortic arch plaque. Assessing aortic arch plaque combined with a specific prevention strategy may reduce the risk of its feared complication, stroke.