From the Guidelines
Yes, an aneurysm of the brachiocephalic artery could potentially be a source of cardioembolic strokes. The brachiocephalic artery is a major vessel that supplies blood to the right arm, neck, and head, and an aneurysm in this location can lead to thrombus formation and subsequent embolism to the brain, causing ischemic strokes 1.
Pathophysiology and Risk Factors
The turbulent blood flow within the aneurysm can lead to thrombus formation along the aneurysm wall, which can break off and travel as emboli through the right common carotid artery to the brain, causing ischemic strokes. The risk of cardioembolic stroke from a brachiocephalic artery aneurysm is increased in patients with large aneurysms, rapidly expanding aneurysms, or those with symptoms such as upper-extremity claudication, subclavian steal, TIA, or stroke.
Management and Treatment
Management of brachiocephalic artery aneurysms typically involves antiplatelet therapy (such as aspirin 81-325mg daily or clopidogrel 75mg daily) and/or anticoagulation (such as warfarin with target INR 2-3) depending on the specific characteristics of the aneurysm and patient risk factors 1. Surgical repair or endovascular stenting may be necessary for large aneurysms (typically >5.5cm), rapidly expanding aneurysms, or those causing symptoms.
Monitoring and Surveillance
Regular imaging surveillance with ultrasound, CT angiography, or MR angiography is essential to monitor aneurysm size and morphology, as recommended by the 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease 1.
Key Considerations
While brachiocephalic aneurysms are less common than other sources of cardioembolic stroke, they represent an important consideration in the differential diagnosis of stroke, particularly in patients with right-sided cerebral infarcts. A high index of suspicion and prompt evaluation with imaging studies are necessary to diagnose and manage brachiocephalic artery aneurysms effectively.
From the Research
Aneurysm of the Brachiocephalic Artery as a Source of Cardioembolic Strokes
- An aneurysm of the brachiocephalic artery can be a source of cardioembolic strokes, as evidenced by a case report of a 70-year-old man who presented with abnormal left arm movements, left hemianopia, and loss of balance due to an isolated brachiocephalic artery aneurysm with associated plaque rupture, contributing to recurrent episodes of transient ischemic attack 2.
- The brachiocephalic artery aneurysm can cause symptoms related to thrombosis or compression, and may require surgery to prevent further complications such as stroke or rupture 3.
- A study of 73 patients with brachiocephalic aneurysms found that 31.5% presented with stroke or transient ischemic attacks, highlighting the potential for these aneurysms to cause cardioembolic strokes 4.
- The management of transient ischemic attack and acute ischemic stroke involves the use of antithrombotic therapy, such as dual antiplatelet therapy or oral anticoagulants, to reduce the risk of recurrent stroke or thromboembolism 5, 6.
- In patients with non-valvular atrial fibrillation, oral anticoagulants are preferred over antiplatelets or no antithrombotic treatment for secondary prevention of stroke and other vascular outcomes 6.