-Case Reports-

Shaggy Aorta Syndrome after Cerebral Angiography: A Case Report

Hiroyuki Dan¹, Minoru Ideguchi¹, Kyongsong Kim¹, Kenta Koketsu¹, Masashi Abe² and Yasuo Murai³

¹Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
²Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
³Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan

Shaggy aorta refers to an aorta with intimal roughening due to atheromatous aortic plaques. Catheterization and anticoagulation therapy can result in cholesterol emboli, potentially leading to systemic organ infarction. Contrast-enhanced computed tomography (CT) and transesophageal echocardiography are commonly used to diagnose shaggy aorta. A patient in his ninth decade of life had a history of right occipital lobe ischemic stroke, bilateral internal carotid artery stenosis, and shaggy aorta syndrome related to transfemoral cerebral angiography. Dysarthria occurred immediately after the procedure. Brain magnetic resonance imaging (MRI) confirmed cerebral infarction, and anticoagulant therapy was administered. Four days later, after observing numbness of the left 5th finger and purplish discoloration of the tips of the 2nd and 5th fingers, we performed contrast-enhanced CT and diagnosed shaggy aorta. There was no renal impairment or eosinophilia and the patient was discharged 16 days after the examination. Aortic MRI performed 1 month later revealed an unstable plaque in the vessel wall. Although we report our experience with a single patient, we recommend that patients scheduled for cerebral angiography, especially those with severe arteriosclerosis, undergo preprocedural aortic fast spoiled gradient echo MRI screening to avoid shaggy aorta syndrome.

J Nippon Med Sch 2025; 92: 409-413

Keywords
shaggy aorta, cerebral angiography, aortic MRI, screening, cholesterol embolism

Correspondence to
Hiroyuki Dan, MD, Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba 270-1694, Japan
h-dan@nms.ac.jp

Received, December 2, 2023
Accepted, June 17, 2024