Imaging the aortic arch to improve diagnostic and prognostic accuracy in transient ischemic attack patients

This study raises a final relevant question: since the prognosis of TIA patients worsens in proportion to the severity of AAA, what therapeutic options are available for these patients? The clinical guidelines recommend risk factor modification and therapy with statins (Class IIa, level of evidence C), an approach consistent with treatment of any patient affected by atherosclerosis. Treatment with coumadin or anti-platelet agents can be considered in patients with AAA >4 mm, i.e. severe AAA, but it remains very controversial because of a potential risk of thrombo-embolism (Class IIb, level of evidence C) . Finally, surgical intervention has been fraught with a much higher rate of stroke than medical therapy and it is therefore avoided in most cases. Evidently more work remains to be done on the therapeutic front. Nonetheless, Guidoux and colleagues added an important piece of evidence to the puzzling diagnostic question of the origin of emboli that caused a cryptogenic TIA, and it is therefore incumbent upon the imaging physician to not overlook the aortic arch as a frequent source of thrombo-embolic disease.
Source: Atherosclerosis - Category: Cardiology Authors: Tags: Invited Commentaries Source Type: research