Shaggy Aorta Syndrome after Cerebral Angiography: A Case Report

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.