Abdominal Aortic Aneurysm as a Marker of Systemic Atherosclerosis in a Patient with Prior Coronary Bypass and Fatal Middle Cerebral Artery Stroke: A Cadaveric Case Study

Moultrie, GA

INTRODUCTION: Abdominal aortic aneurysm (AAA) is frequently associated with systemic atherosclerotic disease and increased risk for cardiovascular morbidity. The development of AAA is attributed to hypertension, smoking tobacco, and other factors such as genetics. Patients with vascular diseases also develop multisystem involvement, including coronary, cerebrovascular, and cardiac conduction abnormalities. The purpose of this case study was to investigate the role artherosclerotic disease played the in the fatal left middle cerebral artery (MCA) ischemic stroke of a 75-year-old male with a visible abdominal aortic aneurysm, history of coronary artery bypass grafting (CABG), and permanent pacemaker implantation.

METHODS: Systematic gross anatomical dissection examination was performed of the cardiovascular and cerebrovascular systems, including evaluation of the abdominal aorta, carotid arteries, axillary arteries, femoral arteries, and heart. Samples from these arteries were sent to Colquitt Regional Medical Center for hematoxylin and eosin (H&E) staining to confirm plaque deposits consistent with atherosclerotic disease. Visible documentation was provided of Macroscopic calcification crystals in the dissected cross-section of the abdominal aortic aneurysm.

RESULTS: Gross examination revealed a large abdominal aortic aneurysm containing visible calcification and luminal dilation consistent with vascular remodeling. The coronary vasculature demonstrated evidence of a CABG using the internal thoracic artery, supporting a history of significant coronary artery disease. Examination of the carotid, and other arteries revealed findings consistent with large-artery atherosclerosis. The brain demonstrated features of degraded tissue consistent with a left MCA territory infarction. Histological analysis confirmed atherosclerotic plaque formation.

CONCLUSIONS: These case findings support progressed atherosclerotic disease present in multiple arteries validating large-artery atherosclerosis as the primary mechanism of fatal MCA stroke. This case highlights the anatomical correlation between systemic atherosclerosis and multisystem vascular pathology observed in this cadaveric study. It reinforces the concept that diffuse large-artery atherosclerosis can simultaneously affect coronary, aortic, and cerebrovascular regions, predisposing patients to ischemic stroke.