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PubMed1997

[Preoperative embolization in the treatment protocol for rhinopharyngeal angiofibroma: comparison of the effectiveness of various materials].

The authors examine the effectiveness of preoperative embolization in the treatment of rhinopharyngeal angiofibroma. In addition, they evaluate the effect various embolizing substances have in the aim of establishing what is the ideal time interval between embolization and surgery. Thirteen patients with rhinopharyngeal angiofibroma (3 were recurrences) were submitted to preoperative embolization. Of these, 4 were treated with a reabsorbable microparticulate substance (Gelfoam) while the remaining 8 were treated with non reabsorbable microparticulate substances (Ivalon, ITC contour, Terbal). The time interval between embolization and surgery ranged from a minimum of 1 day with a maximum of 4 days. The authors conclude that embolization markedly reduces blood loss during surgery, so much so that the available blood supply was not required. As regards the various embolizing substances and the time lapse between embolization and surgery, the authors feel that when using reabsorbable materials the interval should not exceed 48 hours so that the supply artery can quickly be recanalized. On the other hand, for the materials which are not reabsorbed, the time interval can exceed 48 hours but must be less than 4 days because collateral circulation can arise.

Adolescent↗
PubMed1998

Embolization and serum lysozyme activity in renal cancer.

The aim of the study was to determine the effect of renal tumor embolization on nonspecific immunity by evaluating lysozyme activity and leucocytosis in 45 patients and 40 healthy people. Lysozyme activity was assessed in the non-diluted serum (A1) and in the tenfold diluted serum (B1) prior to embolization and after embolization (A2, B2) and in control group. Prior to embolization, lysozyme activity was lower in the experimental group (A1 and B1), compared to the control groups, the differences being statistically significant (p < 0.05). After embolization, the activity became normalized (A2), reaching the control value and even exceeding it (C) in the diluted serum (B2). Leucocytosis prior to embolization (L1) resembled that of control group, increasing slightly after embolization (L2). The differences observed in the changes in lysozyme activity and leucocytosis were statistically significant (p < 0.05). Our findings indicate an inhibitory effect of the neoplastic process on nonspecific immunity. Embolization causes ischemic necrosis of tumor and products of neoplastic tissue disintegration exert a stimulating effect on granulopoiesis, by increasing the turnover of neutrophilic granulocytes. Granulocytic-monocytic infiltrations in tumor stroma are the source of lysozyme, enhancing not only local but also systemic immunity, which is manifested in the increased lysozyme activity in blood serum.

Adult↗
PubMed1976

Paradoxical embolism. A diagnostic challenge and its detection during life.

Two cases of paradoxical embolism, one with recurrent cerebral embolism and one with brachial and coronary embolism and both associated with pulmonary embolism, were diagnosed during life. Although there was neither pulmonary hypertension nor intracardiac shunt present at the time of cardiac catheterization in both cases, the presence of a patent foramen ovale with an interatrial right-to-left shunt was demonstrated by a simple ascorbate dilution technique following a Valsalva maneuver. Each patient was treated by surgical interruption of the inferior vena cava and did well. Paradoxical embolism should be included in the differential diagnosis of arterial embolism for which there is no obvious source, especially when there is also evidence of venous thrombosis or pulmonary embolism.

Cardiac Catheterization↗
PubMed2002

Relationships between embolism, stem water tension, and diameter changes.

A model for embolism in the sapflow process was developed, in which embolism is described as a physical process linked to real physical properties of the conduits and the thermodynamic state of water. Different mechanisms leading to embolism and their effect on water relations and especially diurnal diameter changes in a tree were examined. The mechanisms of heterogeneous nucleation, air-seeding, and bubble growth have been considered. The significance of embolism has been revealed here by examining diameter changes, which is an easily measurable quantity under field conditions. The most fundamental effects of embolism on sapflow are decrease in permeability and release of water from embolizing conduits to the transpiration stream. These can be indirectly detected by observing diameter changes. If possible changes in elasticity are not accounted for, embolism generally tends to enhance the amplitude of the diurnal diameter changes due to reduced permeability and increased tensions. In the case of reduced elasticity, embolism gives rise to smaller amplitudes of diameter changes.

Circadian Rhythm↗
PubMed1997

p53 accumulation and apoptosis in embolized meningiomas.

Preoperative embolization of meningiomas is performed to decrease blood loss at surgery. While it is also expected to reduce tumor recurrence by producing necrosis at the site of dural attachment, very little has been described about what happens to the non-necrotic tumor cells. We investigated how the proliferative activities of meningiomas were modified after embolization. In nine meningiomas which were embolized preoperatively, proliferative potentials and expression of cell cycle inhibitors were assessed immunohistochemically using MIB-1, anti-53 (DO-1 and DO-7), and anti-p21 (WAF1/CIP1) monoclonal antibodies. To determine whether a cell underwent apoptotic death besides necrosis, we applied the terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick end labeling method. Results were compared with control meningiomas without embolization. MIB-1 positive cells often gathered in perinecrotic areas, although the mean MIB-1 staining index of the embolized meningiomas was not significantly different from the control. p53 and its downstream effector p21 accumulated mainly in the perinecrotic areas in eight of the nine embolized meningiomas. Apoptosis was also observed in the concomitant areas. Double staining for both MIB-1 and p21 frequently showed positive cells for both antibodies. The accumulation of MIB-1 positive cells in the embolized meningiomas may not be a sign of fast growth or malignancy, but it may implicate arrest of cell cycle by the p21. This study indicates that embolized meningiomas exhibit not only necrosis but also apoptosis and cell cycle arrest. The latter effects appear to be at least partly p53 dependent.

Adult↗
PubMed2005

The practical value of applying chemical biliary duct embolization to chemical hepatectomy for treatment of hepatolithiasis.

BACKGROUND: The high recurrence rate of hepatolithiasis, together with the high operative risk of hepatectomy for specifically located stones, has not been effectively settled until now. Thus, the aim of this study was to investigate the feasibility and effectiveness of using chemical biliary duct embolization (CBDE) to achieve chemical hepatectomy in a rabbit model of hepatolithiasis. MATERIALS AND METHODS: The animal model of hepatolithiasis was established using the methods of obstruction plus infection. Seven days later, the left hepatic ducts were embolized using phenol plus cyanoacrylate or absolute ethanol plus cyanoacrylate. Subsequently, the influence of CBDE on bile duct, liver, and stone formation was analyzed by histology, RT-PCR for procollagen, biochemistry, and enzymatic histochemistry for beta-glucuronidase (beta-G). RESULTS: CBDE resulted in the entire ablation of the diseased biliary duct mucosa and the complete occlusion of the diseased biliary duct lumen, thus effectively eradicating chronic proliferative cholangitis and preventing stone formation. More importantly, CBDE also resulted in the complete fibrosis and "self-cut" in the periphery of the embolized lobe, thus achieving chemical hepatectomy. Also of note, the embolized lobe exhibited a much lower level of endogenous beta-G than the nonembolized lobe, indicating an inhibitory effect of CBDE on beta-G. Besides, the mRNA level of procollagen I in the embolized bile duct wall of phenol embolization group was significantly higher than the ethanol embolization group. CONCLUSION: Chemical biliary duct embolization, especially using phenol plus cyanoacrylate, may prevent the recurrence of intrahepatic stone and concurrently achieve the effect of chemical hepatectomy.

Animals↗
PubMed1986

Thrombosis and embolism from cardiac chambers and infected valves.

In a number of cardiac conditions (acute myocardial infarction, chronic left ventricular aneurysm, dilated cardiomyopathy, infective endocarditis and atrial fibrillation in the absence of valvular disease), the risk of embolism gives cause for concern. Although anticoagulation with warfarin (Coumadin)-derivatives has been shown to be effective in some of these situations, there is no evidence regarding the role of antiplatelet agents. The common factor in the thromboembolic potential of acute myocardial infarction, chronic left ventricular aneurysm and dilated cardiomyopathy is mural thrombus. This can be detected by two-dimensional echocardiography and indium-111 platelet scintigraphy. Although of value in elucidating the natural history of mural thrombus, in most cases, management is not substantially aided by these investigations. In patients with extensive myocardial infarction, particularly anterior infarction, moderate intensity anticoagulation started soon after hospital admission reduces the rate of embolism. After 8 to 12 weeks, embolic risk is low so that anticoagulants can usually be discontinued. Patients with chronic left ventricular aneurysm have a low incidence of embolism; anticoagulation is, therefore, inappropriate. Dilated cardiomyopathy is associated with a high risk of embolism; moderate intensity anticoagulation may be advisable in many such cases. Little information is available regarding the incidence of thromboembolism or the role of antithrombotic therapy in the patient with a diffusely dilated left ventricle due to ischemic heart disease. In native valve infective endocarditis, the risk of hemorrhage is high, and the efficacy of conventional anticoagulants unclear; thus, anticoagulation should not be instituted for the cardiac condition as such. However, in prosthetic valve endocarditis, the risk of embolism seems to be very high, and anticoagulant therapy should be continued, but with great care because there is a substantial risk of cerebral hemorrhage. Atrial fibrillation in patients with valvular heart disease is dealt with in a previous review. Patients with nonvalvular atrial fibrillation are at varying risk of embolism, depending on the etiology of the arrhythmia; trials of antithrombotic therapy are needed for the various subsets of patients. In most elderly patients, the etiology is not known, and their stroke risk is high. The risk of embolism in younger patients with idiopathic atrial fibrillation is so low as to make any antithrombotic therapy unnecessary.(ABSTRACT TRUNCATED AT 400 WORDS)

Anticoagulants↗
PubMed1998

Laparoscopic renal cryotherapy in swine: comparison of puncture cryotherapy preceded by arterial embolization and contact cryotherapy.

Variable results of open, percutaneous, and laparoscopic cryosurgery of the kidney have been reported. Minimally invasive approaches to lower-pole renal ablation were prospectively compared in swine: laparoscopic puncture cryoablation preceded by arterial embolization, laparoscopic contact cryosurgery, and arterial embolization alone. Eighteen kidneys in nine domestic pigs were randomized to one of three treatment groups of six organs each: (1) puncture cryotherapy preceded by selective lower-pole arterial embolization; (2) contact cryotherapy alone; and (3) arterial embolization alone. Under general anesthesia, appropriate animals underwent selective arterial embolization of the lower pole via femoral cutdown using Gelfoam pledgets. Animals randomized to cryotherapy underwent dissection of the lower pole of the kidney using a single 12-mm umbilical and two midclavicular-line ports in the lateral position. Under external ultrasound guidance, two 3-mm cryoprobes (Cryomedical Sciences, Rockville, MD) were positioned in the lower pole of the kidney, and double-freeze technique to -190 degrees C was performed using puncture or contact application. Ultrasonography was used to guide probe insertion during puncture cryotherapy only. Kidneys were harvested 11 to 14 days after the procedure. Both puncture and contact kidneys demonstrated cell death and subsequent necrosis by light microscopy and electron micrography. On average, puncture lesions were heavier than contact lesions, 19.3 g v 10.1 g (P = 0.02; unpaired t-test), whereas the kidneys were equivalent in weight: 74.1 g v 74.1 g. Puncture lesions represented 26.4% of total kidney weight v 13.5% in the contact group (P = 0.002; unpaired t-test). Only focal infarcts were identified in the embolization group. No evidence of adjacent visceral injury was identified in any of the groups, and no animal required conversion to open laparotomy. One kidney bled after contact cryotherapy, and hemostasis was achieved laparoscopically. Laparoscopic cryotherapy is reproducible and effective using either the puncture technique preceded by arterial embolization or the contact technique, without evidence of damage to adjacent structures. Contact lesions were less voluminous and more peripheral than puncture lesions. Embolization alone produces focal infarcts and focal zones of cell death.

Animals↗
PubMed2001

Induction of air embolism in xylem conduits of pre-defined diameter.

A new method is presented that enables the induction of embolisms in a fraction of all xylem vessels, based on diameter, at one cut end of a stem segment. The method is based on the different capillary characteristic of xylem vessels of different cross-sectional size. To verify the method, air embolisms were induced in cut xylem vessels of chrysanthemum (Dendranthemaxgrandiflorum Tzvelev cv. Cassa) stem segments at different xylem tensions and compared with the distribution of gas-filled vessels as visualized by cryo-scanning electron microscopy (Cryo-SEM). At -6 kPa xylem pressure, air-entrance was only induced in large diameter vessels (>30 microm), while at -24 kPa embolisms were induced in almost all xylem vessels (>10 microm). Although the principle of the embolization method worked well, smaller diameter vessels were observed to be embolized than was expected according to the calculations. The role of cross-sectional shape and contact angle between xylem sap and vessel wall at the menisci are discussed. After correction for the observed (diameter independent) deviation from circularity of the cross-sectional vessel shape the contact angle was calculated to be approximately 55 degrees. Hydraulic resistance (Rh) measurements before and after embolization showed that the effect of embolizing only large diameter cut xylem vessels had only a small influence on overall Rh of a stem segment. Embolizing all cut xylem vessels at one cut end almost trebled overall Rh. The difference was discussed in the light of the networking capacity of the xylem system.

Asteraceae↗
PubMed2006

Temporal and spatial pattern of embolism induced by pressure collar techniques in twigs of Picea abies.

The pressure collar technique enables the induction of embolism in plant xylem. This artificial cavitation is based on air seeding processes which occur when specific pressure gradients between the air and water phase of the xylem are exceeded. Standard pressure collars and a new point injection technique, which builds up a local potential gradient, were used to study the time and spatial pattern of this process. On twigs of Norway spruce (Picea abies), the cross-sectional and axial pattern, and the time-course of embolism formation were analysed via conductivity and ultrasonic measurements as well as staining experiments. Furthermore, the release of air from the twig surface was studied by immersing twig sections in water. In cross-sections, embolized areas induced by the point injection technique were smaller compared with the standard collar and restricted to a circle sector. Embolism propagated from the pressure collar towards the nearest distal and proximal nodes but not further. A release of air was also observed predominantly at the internode attached to the pressure collar. Embolism rates increased within minutes and reached approximately 80% loss of conductivity after 10 min treatment with the standard collar. The size of air entry points and embolism rates correlated significantly. Embolism formation in wood therefore depends not only on vulnerability thresholds but also on the extent of air-water interfaces within the xylem and on the time of exposure to pressure gradients. These aspects and the propagation of pressure within samples are crucial for pressure collar experiments. In addition, wood architecture influences the extent and pattern of embolism caused by air seeding processes.

Air↗
PubMed2003

Development and recovery from winter embolism in silver birch: seasonal patterns and relationships with the phenological cycle in oceanic Scotland.

Silver birch (Betula pendula Roth) is increasingly used in the United Kingdom for reforestation. However, recent evidence indicates that, under some circumstances, planted birch can suffer serious and repeated mortality of the apical leaders and branches, with consequent loss of apical dominance and the formation of a contorted stem. Plants from 37 seed sources of silver birch from Scotland and northern England planted at two sites were compared for several characteristics related to hydraulic architecture, vulnerability to freeze-thaw cycle induced embolism and spring recovery from winter embolism during the period 2000-2002. Phenological rhythms were also monitored in late winter-early spring to document relationships between phenology and water relations parameters. Significant differences were found across seed sources in stage of bud flushing for four dates in spring. Early flushing seed sources differed by about 1 to 2 weeks from late-flushing seed sources across the two sites. Wintertime xylem embolism in stems reached a peak of about 50 to 70% loss of xylem hydraulic conductivity, depending on the size and position of the sample shoots in the canopy. Small apical shoots were significantly more embolized than large basal shoots. Development of winter embolism was coupled to the occurrence of frost events. As percent loss of hydraulic conductivity increased during the winter, wood relative water content declined. Embolism reversal occurred rapidly in spring at the time of development of positive root pressure. No significant differences in the degree of winter embolism in 2001 were found among the three seed sources examined. The investigation was expanded in the winter-spring of 2002 to include 10 seed sources across both sites. Significant differences were found in degree of winter embolism across sites, dates and seed sources. For each date, there was a significant relationship between flushing scores and wood relative water contents across the two sites and all seed sources, suggesting that differences in time of flushing across sites and seed sources were likely caused by differences in the time of occurrence of root pressure, a necessary precondition to flushing.

Betula↗
PubMed1999

Root xylem embolisms and refilling. Relation To water potentials of soil, roots, and leaves, and osmotic potentials of root xylem Sap

Embolism and refilling of vessels was monitored directly by cryomicroscopy of field-grown corn (Zea mays L.) roots. To test the reliability of an earlier study showing embolism refilling in roots at negative leaf water potentials, embolisms were counted, and root water potentials (Psiroot) and osmotic potentials of exuded xylem sap from the same roots were measured by isopiestic psychrometry. All vessels were full at dawn (Psiroot -0.1 MPa). Embolisms were first seen in late metaxylem vessels at 8 AM. Embolized late metaxylem vessels peaked at 50% at 10 AM (Psiroot -0.1 MPa), fell to 44% by 12 PM (Psiroot -0.23 MPa), then dropped steadily to zero by early evening (Psiroot -0.28 MPa). Transpiration was highest (8.5 μg cm-2 s-1) between 12 and 2 PM when the percentage of vessels embolized was falling. Embolized vessels were refilled by liquid moving through their lateral walls. Xylem sap was very low in solutes. The mechanism of vessel refilling, when Psiroot is negative, requires further investigation. Daily embolism and refilling in roots of well-watered plants is a normal occurrence and may be a component of an important hydraulic signaling mechanism between roots and shoots.

Journal Article↗
PubMed1996

Cerebral Embolism as a Cause of Stroke and Transient Ischemic Attack.

The most frequent cause of stroke and transient ischemic attacks is cerebral embolism. Cardiogenic cerebral embolization is common among patients with any cause of atrial fibrillation (AF) but particularly in AF resulting from rheumatic and arteriosclerotic heart disease. Rare causes of cerebral embolism include fat entering the bloodstream after trauma, tumor cells arising from atrial myxomata, and gas embolism. Cerebral embolic infarctions and their sources of origin can now be confirmed during life by many invasive (I) and noninvasive (NI) procedures including computerized tomography (CT) scanning (NI), magnetic resonance imaging (MR) (NI), contrast angiography (I), digital subtraction angiography (I), magnetic resonance angiography (NI), carotid Doppler and transcranial Doppler (NI), and echocardiography (NI) without and with contrast. These tests visualize the following: embolic occlusions of small and large cerebral arteries, resultant cerebral infarctions in appropriate vascular territories, plaques within the aorta, subclavian, vertebral, and carotid arteries, and mural thrombi located within the heart and aortocephalic arteries. Transcranial Doppler monitoring of the middle cerebral artery detects both small (asymptomatic) and large (symptomatic) cerebral emboli, as well as transseptal cardiac shunting, which is a cause of paradoxical embolization. Holter monitoring detects episodic cardiac dysrhythmias not apparent during routine ECG. CT or MRI identify cerebral infarctions resulting from virtually all large cerebral emboli. Early recognition and identification of types of cerebral embolism are important because of the availability of effective prophylactic therapies. (ECHOCARDIOGRAPHY, Volume 13, September 1996)

Journal Article↗
PubMed1994

Exclusion of atrial thrombus by transesophageal echocardiography does not preclude embolism after cardioversion of atrial fibrillation. A multicenter study.

BACKGROUND: Transesophageal echocardiography (TEE) has been used recently to detect atrial thrombi before cardioversion of atrial arrhythmias. It has been assumed that embolic events after cardioversion result from embolism of preexisting atrial thrombi that are accurately detected by TEE. This study examined the clinical and echocardiographic findings in patients with embolism after cardioversion of atrial fibrillation despite exclusion of atrial thrombi by TEE. METHODS AND RESULTS: Clinical and echocardiographic data in 17 patients with embolic events after TEE-guided electrical (n = 16) or pharmacological (n = 1) cardioversion were analyzed. All 17 patients had nonvalvular atrial fibrillation, including four patients with lone atrial fibrillation. TEE before cardioversion showed left atrial spontaneous echo contrast in five patients and did not show atrial thrombus in any patient. Cardioversion resulted in return to sinus rhythm without immediate complication in all patients. Thirteen patients had cerebral embolic events and four patients had peripheral embolism occurring 2 hours to 7 days after cardioversion. None of the patients were therapeutically anticoagulated at the time of embolism. New or increased left atrial spontaneous echo contrast was detected in four of the five patients undergoing repeat TEE after cardioversion including one patient with a new left atrial appendage thrombus. CONCLUSIONS: Embolism may occur after cardioversion of atrial fibrillation in inadequately anticoagulated patients despite apparent exclusion of preexisting atrial thrombus by TEE. These findings suggest de novo atrial thrombosis after cardioversion or imperfect sensitivity of TEE for atrial thrombi and suggest that screening by TEE does not obviate the requirement for anticoagulant therapy at the time of and after cardioversion. A randomized clinical trial is needed to compare conventional anticoagulant management with a TEE-guided strategy including anticoagulation after cardioversion.

Adult↗
PubMed1999

[Study of relative factors which influenced the embolic level of microspheres in the hamster lingual carcinoma].

OBJECTIVE: To study the relative factors which influence the embolic level of microspheres in the hamster lingual carcinoma. METHODS: Micropicture analysis instrument was used to measure the embolic level of microspheres which were poured through ascending aorta. RESULTS: The optimum pressure of embolization was 30 kPa. The embolic level approached to remote site of the lingual artery as tongue cancer developed. In early invasive cancer period, the embolic level of microspheres was at arteriole level where microspheres block "the total values" which controlled the tumor microcirculation. The optimum embolic result and less offshoot microcirculation were obtained at this time. When in later period, microspheres mainly embolized the meta-arteriole. As the microvessels dilated, the dose of microspheres must be increased to get the best embolic result. CONCLUSION: The experimental data for clinical choice of optimum pouring pressure, optimum opportunity and optimum cases.

Albumins↗
PubMed1977

Effects of pulmonary gas embolism on circulation and respiration in the dog. II. Effects on respiration.

In mongrel dogs weighing 15--25 kg and anesthetized with thiopental-gamma-hydroxybutyric acid the effects of venous gas infusion and injection on several respiratory variables were investigated. During spontaneous respiration pulmonary gas embolism caused an increase of the ventilatory minute volume depending on the degree of embolization. The contribution of breathing frequency and tidal volume to the increase of ventilatory minute volume varied from one animal to the other. During constant artificial ventilation pulmonary gas embolism impaired the pulmonary gas exchange depending on the degree of embolization. How far a steady-state phase in gas exchange can be reached during continuous venous gas infusion depended on the adaptation of the circulation. At severe degrees of embolization circulation as well as gas exchange became deficient. Increasing artificial ventilation during pulmonary gas embolism improved the wash-out of carbon dioxide, but hardly affected the uptake of oxygen. The most important origin of the disturbed gas exchange in pulmonary gas embolism seemed to be an increased inequality of the ventilation-perfusion ratio distribution.

Animals↗
PubMed1998

The role of endothelin-1 as a mediator of the pressure response after air embolism in blood perfused lungs.

OBJECTIVE: It is well known that lung embolism is associated with an increase in pulmonary vascular resistance. Since the mechanisms of pulmonary vascular reactions during embolism are still unclear, the aim of this study was to investigate the potential involvement of endothelin-1 (ET-1) and thromboxane A2 (TXA2) as mediators of the pulmonary artery pressure (PAP) increase after embolism using the selective ETA receptor antagonist LU135252 [1], the ETB receptor antagonist BQ788 [2], and the cyclooxygenase inhibitor diclofenac. DESIGN: Prospective experimental study in rabbits. SETTING: Experimental laboratory in a university teaching hospital. SUBJECTS: 36 adult rabbits of either sex. INTERVENTIONS: The experiments were performed in 36 isolated and ventilated rabbit lungs which were perfused with a buffer solution containing 10% of autologous blood. Embolism was induced by the injection of 0.75 ml air into the pulmonary artery. MEASUREMENTS AND RESULTS: PAP and lung weight, reflecting edema formation, were continuously recorded. Perfusate samples were drawn intermittently to determine TXA2 and ET-1 concentrations. Air injection resulted in an immediate increase in PAP up to 22.8 +/- 1.4 mm Hg at 2.5 min (control, n = 6), which was parallelled by an enhanced generation of TXA2. No relevant edema formation occurred during the observation period. Pretreatment with the ETA receptor antagonist LU135252 significantly reduced the pressure reaction after air embolism (p < 0.001) whereas the ETB receptor antagonist BQ788 (n = 6) was without marked effects. The administration of diclofenac (n = 6) did not alter the PAP increase 2.5 min after embolism, but significantly reduced the pressure reaction during the further observation period (p < 0.001). The application of LU135252 and diclofenac together (n = 6) also significantly reduced the PAP increase from 2.5 min during the total observation period (p < 0.001). CONCLUSIONS: The acute pressure reaction after air embolism is mainly mediated via ET-1 by an ETA receptor related mechanism. TXA2 seems to maintain this reaction for a longer time.

Analysis of Variance↗
PubMed2004

Atheromatous disease of the thoracic aorta and systemic embolism. Clinical picture and therapeutic challenge.

Systemic embolism is a frequent cause of stroke. At the beginning of the last decade by introduction of transesophageal echocardiography and other imaging techniques atheromatosis of the aortic arch has been recognized as an important source of embolism. Formerly in the pre-TEE era, this entity was included into cryptogenic strokes. Aortic atheromas are found in about one quarter of patients presenting with embolic events. The severity of atherosclerosis graded by TEE correlates with the risk for future embolism, especially if mobile lesions or superimposed thrombi are present. Independent of plaque extension, patients with unstable plaques characterized by echo-lucency, inhomogenity, lacking of calcifications, ulceration, mobile parts and concomitant spontaneous echo contrast within the aorta have a higher risk for embolic events. However, the diagnosis of aortic atheromatosis is mostly established if an embolic event has already occurred. Therefore, it is important to identify patients at risk, especially before they undergo interventions with manipulation at the aorta like coronary bypass surgery. Risk factors are age above 70, diabetes mellitus, hyperlipidemia, arterial hypertension, aortic calcifications on standard chest X-ray, elevated serum levels of C-reactive protein, other inflammatory markers, and an activated coagulation. Randomized studies for treatment of patients with severe aortic atheromatosis are not yet existing. Warfarin has been shown to prevent stroke in patients with mobile atheromas and superimposed thrombi, but there are case reports about aggravation of cholesterol embolism under warfarin treatment. It is concluded from other atherosclerotic manifestations that plaque stabilizing treatment with statins and ACE inhibitors is also beneficial.

Aorta, Thoracic↗