Ann Rehabil Med.  2013 Oct;37(5):750-754. 10.5535/arm.2013.37.5.750.

Recurrent Cerebral Infarction Caused by Mobile Aortic Arch Thrombus Refractory to Warfarin Therapy

• Bok SK
• Lee YJ
• Ahn SY

• KMID: 2266598
• DOI: http://doi.org/10.5535/arm.2013.37.5.750

Abstract

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.

Keyword

Aorta; Thrombus; Stroke; Transesohphageal echocardiography

MeSH Terms

Aorta
Aorta, Thoracic*
Aspirin
Cerebral Infarction*
Echocardiography, Transesophageal
Heart
Heparin
Heptanoic Acids
Humans
International Normalized Ratio
Pyrroles
Stroke
Thrombosis*
Warfarin*
Atorvastatin Calcium
Aspirin
Heparin
Heptanoic Acids
Pyrroles
Warfarin

Figure

• 

  Fig. 1 (A) Transesophageal echocardiography demonstrates finger-like mobile thrombi of the aortic arch. (B) Multi-detector computed tomography scan demonstrate intramural hematoma.

• 

  Fig. 2 (A) Brain magnetic resonance imaging, acute infarction on right anterior cerebral arterial territory. (B) Brain magnetic resonance angiography, obstruction of right distal anterior cerebral artery.

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