Aterosklerotik Aort Hastalıkları
Özet
Aterosklerotik aort lezyonları tıp literatüründe farklı şekillerde belirtilmektedir. Bunlar; aterosklerotik plaklar, ateromlar, aterosklerotik kalıntılardır. Tüm bunlara genel olarak plak adı verilmektedir. Plakların hareketli bileşenleri; hareketli plak, hareketli çıkıntılar ve üst üste birikmiş trombuslerdir. Plak kalınlığı 4 mm' yi aştığında elde dilen klinik verilere göre embolizasyon riskinin yüksek olduğu görülmüştür. Bu lezyonlara ciddi plak da denilmektedir. Kompleks plak terimi ise 4 mm yi aşan kalınlıkta olup hareketli bileşen içeren plaklar için kullanılmaktadır. Ateroskleroz, aortik sendromların altında yatan temel nedendir. Klinik prezentasyon aortun tutulum bölgesine göre değişiklik göstermektedir. Karotis arter hastalığı, koroner arter hastalığı, renal arter hastalığı, gibi klinik prezentasyonlar oluşturmaktadır. Ateroskleroz bütün arteriyel vasküler yatağı etkiler ve aort dışı bir bölgede ateroskleroz varlığı, aortik aterosklerotik hastalık olma riskini de artırmaktadır.
Atherosclerotic aortic lesions are specified in different ways in the medical literature. These are; atherosclerotic plaques, atheromas, atherosclerotic residues. All of these are generally called plaques. The mobile components of plaques are; mobile plaque, mobile protrusions and thrombi accumulated on top of each other. When the plaque thickness exceeds 4 mm, it has been observed that the risk of embolization is high according to the clinical data obtained. These lesions are also called serious plaques. The term complex plaque is used for plaques that are over 4 mm thick and contain mobile components. Atherosclerosis is the main cause underlying aortic syndromes. Clinical presentation varies according to the region of involvement of the aorta. It creates clinical presentations such as carotid artery disease, coronary artery disease, renal artery disease. Atherosclerosis affects the entire arterial vascular bed and the presence of atherosclerosis in a region other than the aorta also increases the risk of aortic atherosclerotic disease.
Referanslar
Kronzon I, Tunick PA. Aortic atherosclerotic disease and stroke. Circulation. 2006 Jul 4;114(1):63-75. doi:10.1161/CIRCULATIONAHA.105.593418. PMID: 16818829.
Section XXV - Diseases of the Aorta, Editor(s): Roberto M. Lang, Steven A. Goldstein, Itzhak Kronzon, Bijoy K. Khandheria, Victor Mor-Avi, ASE's Comprehensive Echocardiography (Second Edition), Elsevier, 2016, Pages 659-699.
Meissner I, Khandheria BK, Sheps SG, Schwartz GL, Wiebers DO, Whisnant JP, Covalt JL, Petterson TM, Christianson TJ, Agmon Y. Atherosclerosis of the aorta: risk factor, risk marker, or innocent bystander? A prospective population-based transesophageal echocardiography study. J Am Coll Cardiol. 2004; 44: 1018–1024.
Amarenco P, Cohen A, Tzourio C, Bertrand B, Hommel M, Besson G, Chauvel C, Touboul PJ, Bousser MG. Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med. 1994; 331: 1474–1479.
Jones EF, Kalman JM, Calafiore P, Tonkin AM, Donnan GA. Proximal aortic atheroma: an independent risk factor for cerebral ischemia. Stroke. 1995; 26: 218–224.
Tunick PA, Katz ES, Freedberg RS, Rosenzweig BP, Perez JL, Kronzon I. High risk for vascular events in patients with protruding aortic atheromas: a prospective study. J Am Coll Cardiol. 1994; 23: 1085–1090.
Matsuzaki M, Ono S, Tomochika Y, Michishige H, Tanaka N, Okuda F, Kusukawa R. Advances in transesophageal echocardiography for the evaluation of atherosclerotic lesions in thoracic aorta: the effects of hypertension, hypercholesterolemia, and aging on atherosclerotic lesions. Jpn Circ J. 1992; 56: 592–602.
Konecky N, Malinow MR, Tunick PA Tunick PA, Freedberg RS, Rosenzweig BP, Katz ES, Hess DL, Upson B, Leung B, Perez J, Kronzon I. Correlation between plasma homocyst(e)ine and aortic atherosclerosis. Am Heart J. 1997; 133: 534–540.
Sen S, Oppenheimer SM, Lima J, Cohen B. Risk factors for progression of aorta atheroma in stroke and transient ischemic attack patient. Stroke. 2002; 33: 930–935.
Lochow P, Schwartzbard A, Guest J, Ripps C, Matalon D, Gambetta R, Tunick PA, Sedlis S. Elevated prothrombin and activated protein C resistance in patients with thoracic aortic atheroma. Angiology. 2002; 53: 423–428.
Agmon Y, Khandheria BK, Meissner I, Petterson TM, O’Fallon WM, Wiebers DO, Christianson TJ, McConnell JP, Whisnant JP, Seward JB, Tajik AJ. C-reactive protein and atherosclerosis of the thoracic aorta: a population-based transesophageal echocardiographic study. Arch Intern Med. 2004; 164: 1781–1787
Wongpraparut N, Apiyasawat S, Maraj S, Jacobs LE, Kotler MN. The correlation of left ventricular hypertrophy with the severity of atherosclerosis and embolic events. J Med Assoc Thai. 2005; 88: 156–161.
Di Tullio MR, Sacco RL, Gersony D, Nayak H, Weslow RG, Kargman DE, Homma S. Aortic atheromas and acute ischemic stroke: a transesophageal echocardiographic study in an ethnically mixed population. Neurology. 1996; 46: 1560–1566.
Demopoulos LA, Tunick PA, Bernstein NE, Perez JL, Kronzon I. Protruding atheromas of the aortic arch and neurologic events in patients with carotid artery disease. Am Heart J. 1995; 129: 40–44.
Witteman JC, Kannel WB, Wolf PA, Grobbee DE, Hofman A, D’Agostino RB, Cobb JC. Aortic calcified plaques and cardiovascular disease (the Framingham study). Am J Cardiol. 1990; 66: 1060–1064.
Fazio GP, Redberg RF, Winslow T, Schiller NB. Transesophageal echocardiographically detected atherosclerotic aortic plaque is a marker for coronary artery disease. J Am Coll Cardiol. 1993; 21: 144–150
Parthenakis F, Skalidis E, Simantirakis E, Kounali D, Vardas P, Nihoyannopoulos P. Absence of atherosclerotic lesions in the thoracic aorta indicates absence of significant coronary artery disease. Am J Cardiol. 1996; 77: 1118–1121
Reynolds HR, Tunick PA, Benenstein RJ, Nakra NC, Shah A, Spevack DM, Kronzon I. Severe renal artery stenosis is common in patients with severe thoracic aortic plaque. Am J Cardiol. 2004; 94: 844–846.
Weinberger J, Azhar S, Danisi F, Hayes R, Goldman M. A new noninvasive technique for imaging atherosclerotic plaque in the aortic arch of stroke patients by transcutaneous real-time B-mode ultrasonography: an initial report. Stroke. 1998; 29: 673–676.
Daniel WG, Erbel R, Kasper W, Visser CA, Engberding R, Sutherland GR, Grube E, Hanrath P, Maisch B, Dennig K. Safety of transesophageal echocardiography: a multicenter survey of 10,419 examinations. Circulation.
Rutt BK, Carke SE, Fayad ZA. Atherosclerotic plaque characterization by MR imaging. Curr Drug Targets Cardiovasc Haematol Disord. 2004; 4: 147–159.
Ogawa M, Ishino S, Mukai T, Asano D, Teramoto N, Watabe H, Kudomi N, Shiomi M, Magata Y, Iida H, Saji H. (18)-F-FDG accumulation in atherosclerotic plaques: immunohistochemical and PET imaging study. J Nucl Med. 2004; 45: 1245–1250.
Referanslar
Kronzon I, Tunick PA. Aortic atherosclerotic disease and stroke. Circulation. 2006 Jul 4;114(1):63-75. doi:10.1161/CIRCULATIONAHA.105.593418. PMID: 16818829.
Section XXV - Diseases of the Aorta, Editor(s): Roberto M. Lang, Steven A. Goldstein, Itzhak Kronzon, Bijoy K. Khandheria, Victor Mor-Avi, ASE's Comprehensive Echocardiography (Second Edition), Elsevier, 2016, Pages 659-699.
Meissner I, Khandheria BK, Sheps SG, Schwartz GL, Wiebers DO, Whisnant JP, Covalt JL, Petterson TM, Christianson TJ, Agmon Y. Atherosclerosis of the aorta: risk factor, risk marker, or innocent bystander? A prospective population-based transesophageal echocardiography study. J Am Coll Cardiol. 2004; 44: 1018–1024.
Amarenco P, Cohen A, Tzourio C, Bertrand B, Hommel M, Besson G, Chauvel C, Touboul PJ, Bousser MG. Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med. 1994; 331: 1474–1479.
Jones EF, Kalman JM, Calafiore P, Tonkin AM, Donnan GA. Proximal aortic atheroma: an independent risk factor for cerebral ischemia. Stroke. 1995; 26: 218–224.
Tunick PA, Katz ES, Freedberg RS, Rosenzweig BP, Perez JL, Kronzon I. High risk for vascular events in patients with protruding aortic atheromas: a prospective study. J Am Coll Cardiol. 1994; 23: 1085–1090.
Matsuzaki M, Ono S, Tomochika Y, Michishige H, Tanaka N, Okuda F, Kusukawa R. Advances in transesophageal echocardiography for the evaluation of atherosclerotic lesions in thoracic aorta: the effects of hypertension, hypercholesterolemia, and aging on atherosclerotic lesions. Jpn Circ J. 1992; 56: 592–602.
Konecky N, Malinow MR, Tunick PA Tunick PA, Freedberg RS, Rosenzweig BP, Katz ES, Hess DL, Upson B, Leung B, Perez J, Kronzon I. Correlation between plasma homocyst(e)ine and aortic atherosclerosis. Am Heart J. 1997; 133: 534–540.
Sen S, Oppenheimer SM, Lima J, Cohen B. Risk factors for progression of aorta atheroma in stroke and transient ischemic attack patient. Stroke. 2002; 33: 930–935.
Lochow P, Schwartzbard A, Guest J, Ripps C, Matalon D, Gambetta R, Tunick PA, Sedlis S. Elevated prothrombin and activated protein C resistance in patients with thoracic aortic atheroma. Angiology. 2002; 53: 423–428.
Agmon Y, Khandheria BK, Meissner I, Petterson TM, O’Fallon WM, Wiebers DO, Christianson TJ, McConnell JP, Whisnant JP, Seward JB, Tajik AJ. C-reactive protein and atherosclerosis of the thoracic aorta: a population-based transesophageal echocardiographic study. Arch Intern Med. 2004; 164: 1781–1787
Wongpraparut N, Apiyasawat S, Maraj S, Jacobs LE, Kotler MN. The correlation of left ventricular hypertrophy with the severity of atherosclerosis and embolic events. J Med Assoc Thai. 2005; 88: 156–161.
Di Tullio MR, Sacco RL, Gersony D, Nayak H, Weslow RG, Kargman DE, Homma S. Aortic atheromas and acute ischemic stroke: a transesophageal echocardiographic study in an ethnically mixed population. Neurology. 1996; 46: 1560–1566.
Demopoulos LA, Tunick PA, Bernstein NE, Perez JL, Kronzon I. Protruding atheromas of the aortic arch and neurologic events in patients with carotid artery disease. Am Heart J. 1995; 129: 40–44.
Witteman JC, Kannel WB, Wolf PA, Grobbee DE, Hofman A, D’Agostino RB, Cobb JC. Aortic calcified plaques and cardiovascular disease (the Framingham study). Am J Cardiol. 1990; 66: 1060–1064.
Fazio GP, Redberg RF, Winslow T, Schiller NB. Transesophageal echocardiographically detected atherosclerotic aortic plaque is a marker for coronary artery disease. J Am Coll Cardiol. 1993; 21: 144–150
Parthenakis F, Skalidis E, Simantirakis E, Kounali D, Vardas P, Nihoyannopoulos P. Absence of atherosclerotic lesions in the thoracic aorta indicates absence of significant coronary artery disease. Am J Cardiol. 1996; 77: 1118–1121
Reynolds HR, Tunick PA, Benenstein RJ, Nakra NC, Shah A, Spevack DM, Kronzon I. Severe renal artery stenosis is common in patients with severe thoracic aortic plaque. Am J Cardiol. 2004; 94: 844–846.
Weinberger J, Azhar S, Danisi F, Hayes R, Goldman M. A new noninvasive technique for imaging atherosclerotic plaque in the aortic arch of stroke patients by transcutaneous real-time B-mode ultrasonography: an initial report. Stroke. 1998; 29: 673–676.
Daniel WG, Erbel R, Kasper W, Visser CA, Engberding R, Sutherland GR, Grube E, Hanrath P, Maisch B, Dennig K. Safety of transesophageal echocardiography: a multicenter survey of 10,419 examinations. Circulation.
Rutt BK, Carke SE, Fayad ZA. Atherosclerotic plaque characterization by MR imaging. Curr Drug Targets Cardiovasc Haematol Disord. 2004; 4: 147–159.
Ogawa M, Ishino S, Mukai T, Asano D, Teramoto N, Watabe H, Kudomi N, Shiomi M, Magata Y, Iida H, Saji H. (18)-F-FDG accumulation in atherosclerotic plaques: immunohistochemical and PET imaging study. J Nucl Med. 2004; 45: 1245–1250.
