Abstract
Although embolic stroke accounts for most cerebral infarctions, examinations to identify the embolic source are insufficient. Diagnosing aortogenic stroke in an acute clinical setting is particularly challenging and often occurs after excluding other embolic sources. Recently, nonobstructive general angioscopy (NOGA) has been used to diagnose aortic plaques, revealing the presence of spontaneously ruptured aortic plaques (SRAPs). SRAPs continuously discharge debris containing cholesterol crystals, fibrin, and thrombi and potentially serving as embolic sources, regardless of whether they affect the cerebral cortex or white matter. SRAPs have been suggested to be embolic sources for strokes previously classified as embolic strokes of unknown sources. A systematic diagnosis of cerebral infarction can be achieved through a comprehensive analysis of NOGA findings in the acute phase of cerebral infarction, the pathology of debris expelled by SRAPs, and transesophageal echocardiography findings. Owing to its exceptionally high spatial resolution, NOGA can detect finer SRAPs and excretions than other modalities. These microemboli may be implicated in microcerebral infarctions within the territory of the cerebral perforating arteries. SRAPs have been strongly correlated with microinfarctions, implicating their role in cognitive decline and brain aging. Recognizing aortic-origin cerebral embolism is crucial not only for stroke management but also for addressing senile dementia.
