Montgomery Classification of Aortic Parietal Plaques

May 20, 2022
Pages: 1 – 3

From: Montgomery D.H. Natural history of severe atheromatous disease of the thoracic aorta: a transesophageal echocardiographic study. J Am Coll Cardiol 1996;27:95-101.

Figure 1. Grade I
Figure 1. Grade I
Figure 2. Grade II
Figure 2. Grade II
Figure 3. Grade III
Figure 3. Grade III
Figure 4. Grade IV
Figure 5. Grade V
  • Grade I: Normal or mild intimal thickening
  • Grade II: Extensive intimal thickening
  • Grade III: Atheroma < 5 mm
  • Grade IV: Atheroma ≥ 5 mm
  • Grade V: Mobile lesion

Predictive power of aortic atheromas:

  • For coronary artery disease: presence of aortic plaque (> Grade II) at TEE has 95% sensitivity and 88% specificity.
    Tribouilloy C. et al. Noninvasive prediction of coronary artery disease by transesophageal echocardiographic detection of thoracic aortic plaque in valvular heart disease. Am J Cardiol 1994;74:258
  • For embolic events: At multivariate analysis only protruding atheromas predicted independently events.
    Tunick PA. et al. High risk for vascular events in patients with protruding aortic atheromas: a prospective study. J Am Coll Cardiol 1994;5:1085.
  • For post-operative embolic events: At logistic regression analysis, only aortic arch atheromas predict post-operative stroke in older patients.
    Katz ES. et al. Protruding aortic atheromas predict stroke in elderly patients undegoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardiol 1992;20:70.


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