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Valenzuela-Fuenzalida JJ, Orellana-Donoso M, Perez-Jiménez D, Farfán-Cabello E, Gold-Semmler M, Becerra-Farfan A, Román C, Nova-Baeza P. Systematic review and meta-analysis of right subclavian artery variants and their correlation with cervical-thoracic clinical conditions. Medicine (Baltimore) 2024; 103:e36856. [PMID: 38394517 DOI: 10.1097/md.0000000000036856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND A high incidence of anatomical variations in the origin of the branches of the aortic arch has been reported, Nowadays, this variation is considered the most frequent in the aortic arch, its prevalence being estimated between 0.5% and 2.5% of the population. To understand its origin, knowledge of embryonic development is necessary. METHODS We searched the MEDLINE, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, and Latin-American literature and caribean of health sciences databases with dates ranging from their inception to June 2023. Study selection, data extraction, and methodological quality were assessed with the guaranteed tool for anatomical studies (Anatomical Quality Assurance). Finally, the pooled prevalence was estimated using a random effects model. RESULTS Thirty-nine studies were found that met the eligibility criteria. Twenty studies with a total of 41,178 subjects were included in the analysis. The overall prevalence of an ARSA variant was 1% (95% confidence interval = 1%-2%), the clinical findings found are that if ARSA is symptomatic it could produce changes in the hemodynamic function of the thoracocervical region in addition to other associated symptomatic complications in surrounding structures. CONCLUSIONS ARSA can cause several types of alterations in the cervical or thoracic region, resulting in various clinical complications, such as lusory dysphagia. Hence, knowing this variant is extremely important for surgeons, especially those who treat the cervico-thoracic region. The low prevalence of ARSA means that many professionals are completely unaware of its existence and possible course and origin. Therefore, this study provides detailed knowledge of ARSA so that professionals can make better diagnoses and treatment of ARSA.
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Affiliation(s)
- Juan José Valenzuela-Fuenzalida
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
- Department of Morphology and Function, Faculty of Health, University of the Americas Santiago, Chile
| | - Mathias Orellana-Donoso
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
- Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Daniela Perez-Jiménez
- Department of Morphology and Function, Faculty of Health, University of the Americas Santiago, Chile
| | - Emilio Farfán-Cabello
- Departamento de Anatomía, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marjorie Gold-Semmler
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
| | - Alvaro Becerra-Farfan
- Departamento de Ciencias Química y Biológicas Facultad de Ciencias de la Salud, Universidad Bernardo O'Higgins
| | - Camila Román
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
| | - Pablo Nova-Baeza
- Department of Morphology, Faculty of Medicine, Universidad Andrés Bello, Santiago, Chile
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Zijderhand CF, Sjatskig J, Scharink DA, Peek JJ, Birim O, Bekkers JA, Bogers AJJC, Caliskan K. Aortic arch branching variations and risk of cerebrovascular accidents in patients with a left ventricular assist device. J Cardiovasc Med (Hagerstown) 2024; 25:44-50. [PMID: 38079280 PMCID: PMC10720834 DOI: 10.2459/jcm.0000000000001570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/07/2023] [Indexed: 12/17/2023]
Abstract
AIMS This retrospective study investigated the association between anatomical variations in the aortic arch branching and adverse events, including the risk of cerebrovascular accidents (CVAs), in patients with a left ventricular assist device (LVAD). METHODS Medical charts were reviewed for all patients with HeartMate 3 LVAD support at our center from 2016 to 2021. Computed tomography scans were evaluated to categorize the variations in the aortic arch branching based on seven different types, as described in the literature. RESULTS In total, 101 patients were included: 86 (85.1%) with a normal branching pattern and 15 (14.9%) with an anatomical variation. The following variations were observed: eight (7.9%) with a bovine arch and seven (6.9%) with a left vertebral arch. The median age was 57 years, 77.2% were men, and the median follow-up was 25 months. No difference was found in the rate of early (< 30 days) re-exploration due to bleeding after LVAD implantation. The rate of CVA and mortality did not differ significantly between patients with a normal arch or an anatomical variation during follow-up, with hazard ratios of 1.47 [95% confidence interval (CI): 0.48-4.48; P = 0.495] and 0.69 (95% CI: 0.24-1.98; P = 0.489), respectively. CONCLUSION This preliminary study showed no differences in early and long-term adverse events, including CVA, when comparing patients with a variation in the aortic arch branching to patients with a normal aortic arch. However, knowledge of the variations in aortic arch branching could be meaningful during cardiac surgery for potential differences in surgical events in the perioperative period.
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Affiliation(s)
| | | | | | - Jette J Peek
- Thoraxcenter, Department of Cardiothoracic Surgery
| | - Ozcan Birim
- Thoraxcenter, Department of Cardiothoracic Surgery
| | | | | | - Kadir Caliskan
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Satam K, Sorondo S, Paisley M, Chandra V. Hybrid repair of an innominate artery pseudoaneurysm after blunt traumatic injury in a bovine arch. J Vasc Surg Cases Innov Tech 2023; 9:101225. [PMID: 38106347 PMCID: PMC10725054 DOI: 10.1016/j.jvscit.2023.101225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/08/2023] [Indexed: 12/19/2023] Open
Abstract
Innominate artery injury is an uncommon consequence of blunt trauma to the neck due to its protected position behind the thorax. A 38-year-old male presented as a trauma with a right-sided pseudoaneurysm emanating from the distal innominate artery after falling from a three-story building. On imaging, he also had a bovine arch. He underwent hybrid repair with covered stent placement from the common carotid into the innominate artery, carotid-subclavian bypass, and plugging of the subclavian artery. The patient recovered with no cerebral insult, neurological deficits, or rupture. Post-traumatic innominate artery pseudoaneurysms can successfully be repaired via a hybrid surgical approach.
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Affiliation(s)
| | - Sabina Sorondo
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA
| | | | - Venita Chandra
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA
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Montorsi P, Galli S, Teruzzi G, Gili S, Trabattoni D. The 'Trawl Fishing' Technique: A Quick Engagement of the Left Common Carotid Artery With the Simmons Catheter During Carotid Artery Stenting From the Right Radial Approach. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 54:57-60. [PMID: 37085354 DOI: 10.1016/j.carrev.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Transradial approach for carotid artery stenting (TRCAS) is an established technique in specific anatomies potentially associated with high periprocedural event rate from femoral catheterization. The engagement of left common carotid artery originating from the aortic arch is the most challenging scenario requiring specific catheters and techniques. METHODS Among 542 consecutive TRCAS 66 had left, non-bovine carotid stenosis as the target vessel. We retrospectively compared the feasibility, safety, efficacy, fluoroscopy time and radiation exposure of two different techniques, the standard (ST) and the 'trawl-fishing' (TFT), to engage the LCCA with the 5F, 125 cm-long Simmons-2 catheter. RESULTS The ST was initially used in 20 patients with a technical success of 85 % (17/20). In the following 46 patients, the TFT was successfully tested first as bailout after ST failure in 12 cases and as first option in the remaining 34 patients. Full technical success was obtained in all patients at the first attempt. No MACCEs or vascular complications occurred in all patients. Fluoroscopy time and radiation exposure were significantly lower with the TFT vs. ST (p < 0.001). CONCLUSIONS TFT represents a definite improvement in the technique of LCCA engagement during TRCAS.
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Affiliation(s)
- Piero Montorsi
- Department of Clinical Sciences and Community Health, University of Milan, Italy; Centro Cardiologico Monzino, IRCCS, Milan, Italy.
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Ryu B, Mochizuki T, Kushi K, Ishikawa T, Shima S, Sato S, Inoue T, Kawamata T, Niimi Y. Optimal guiding catheter position during advancement of the guiding catheter into the carotid artery from the aortic arch via transfemoral approach. Neuroradiol J 2023; 36:470-478. [PMID: 36661360 PMCID: PMC10588598 DOI: 10.1177/19714009221150858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Guiding catheter (GC) advancement into the target carotid artery is a crucial step in neuroendovascular therapy. In difficult anatomies, alternative methods have been reported to overcome difficult carotid access for swift GC advancement. However, studies focusing on the positional relationship between the GC and inner catheter (IC) at the aortic arch are lacking. METHODS We evaluated the impact of the positional relationship between the GC and IC on whether the GC position affects catheter support or system straightening. We retrospectively reviewed 89 patients who underwent neuroendovascular therapy. We assessed the time to carotid access across difficult arch anatomies. The GC position was divided into Position 1, descending aorta level; Position 2, aortic arch level; and Position 3, origin of the left common carotid artery or innominate artery. We also evaluated the GC support and straightening effects in an in vitro vascular model study. RESULTS The coaxial catheter flexion angle at the aortic arch was significantly larger when the GC was set to Position 3 (p < 0.0001). A significantly shorter time to carotid access was observed with Positions 2 and 3 than with Position 1 in the difficult arch anatomy group. In the in vitro vascular model evaluation, the catheter support effect significantly increased as the GC position became closer to the IC tip (p < 0.0001) and straightening effect significantly increased as the GC moved to Position 2 from Position 1 (p < 0.0001). CONCLUSION During GC advancement, the GC positional relationship changed the support of the coaxial system with system straightening. The optimal GC position, Position 3, facilitated swift GC advancement.
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Affiliation(s)
- Bikei Ryu
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Chuo-ku, Japan
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
- Department of Neurosurgery, Tokyo Women’s Medical University, Shinjuku-ku, Japan
| | - Tatsuki Mochizuki
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
| | - Kazuki Kushi
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
| | - Tomomi Ishikawa
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
- Department of Neurosurgery, Tokyo Women’s Medical University, Shinjuku-ku, Japan
| | - Shogo Shima
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
| | - Shinske Sato
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Chuo-ku, Japan
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
- Department of Neurosurgery, Tokyo Women’s Medical University, Shinjuku-ku, Japan
| | - Tatsuya Inoue
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women’s Medical University, Shinjuku-ku, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Chuo-ku, Japan
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Liu W, Li J, Zhou B. A rare case of aortic arch variation complicated with multiple ruptured intracranial aneurysms. Vascular 2023:17085381231164450. [PMID: 36921616 DOI: 10.1177/17085381231164450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
OBJECTIVES Previous reports on aortic arch variations have emphasized on its cardiovascular significance. We present a case of a rare variation of aortic arch complicated with multiple ruptured intracranial aneurysms. METHODS This case report reviews the effects of the diameter of internal carotid artery of isolated origins on cerebral vessels. RESULTS The brachiocephalic trunk, left external carotid artery, left internal carotid artery, left vertebral artery, and the left subclavian artery originating from the aortic arch complicated with multiple ruptured intracranial aneurysms have not been reported. CONCLUSIONS Variation of the aortic arch may affect carotid and cerebral vessel structures as well as blood flow and is a potential risk factor for stroke. Third aortic arch degeneration, or dorsal aorta non-degeneration, is a potential embryologic mechanism for the absence of the left common carotid artery.
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Affiliation(s)
- Wei Liu
- Department of Neurology, 74713Lanzhou University Second Hospital, Lanzhou, China
| | - Jialu Li
- 628743School of Nursing, Lanzhou University, Lanzhou, China
| | - Baoyuan Zhou
- Department of Neurosurgery, 74713Lanzhou University Second Hospital, Lanzhou, China
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Andrée D, Thanabalasingam A, Teubner J, Fahrni M, Potthast S. Diagnostic Value of Computed Tomography Angiography in Suspected Acute Ischemic Stroke Patients With Respect to National Institutes of Health Stroke Scale Score. J Comput Assist Tomogr 2023; Publish Ahead of Print:00004728-990000000-00162. [PMID: 37380153 DOI: 10.1097/rct.0000000000001458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVE Noncontrast computed tomography (NCCT) plus computed tomography angiography (CTA) is the standard imaging modality for acute stroke. We investigated whether there is an additional diagnostic value of supra-aortic CTA in relation to National Institutes of Health Stroke Scale (NIHSS) and resultant effective radiation dose. METHODS In this observational study, 788 patients with suspected acute stroke were included and divided into 3 NIHSS groups: group 1, NIHSS 0-2; group 2, NIHSS 3-5; and group 3, NIHSS ≥ 6.Computed tomography scans were assessed for findings of acute ischemic stroke and vascular pathologies in 3 regions. Final diagnosis was obtained from medical records. Effective radiation dose was calculated based on the dose-length product. RESULTS Seven hundred forty-one patients were included. Group 1 had 484 patients, group 2 had 127 patients, and group 3 had 130 patients. Computed tomography diagnosis of acute ischemic stroke was made in 76 patients. In 37 patients, a diagnosis of acute stroke was made based on pathologic CTA findings in case of an unremarkable NCCT. Stroke occurrence was the lowest in groups 1 and 2, with 3.6% and 6.3%, respectively, compared with 12.7% in group 3. If both NCCT and CTA were positive, the patient was discharged with a stroke diagnosis. Male sex had the highest effect on the final stroke diagnosis. The mean effective radiation dose was 2.6 mSv. CONCLUSIONS In female patients with NIHSS 0-2, additional CTA rarely contains relevant additional findings decisive for treatment decisions or overall patient outcomes; therefore, CTA in this patient group might yield less impactful findings, and the applied radiation dose could be lowered by approximately 35%.
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Affiliation(s)
- Daniel Andrée
- From the Institute of Radiology, Limmattal Hospital, Schlieren, Switzerland
| | | | - Jonas Teubner
- Institute of Neurology, Limmattal Hospital, Schlieren, Switzerland
| | - Markus Fahrni
- From the Institute of Radiology, Limmattal Hospital, Schlieren, Switzerland
| | - Silke Potthast
- From the Institute of Radiology, Limmattal Hospital, Schlieren, Switzerland
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Montorsi P, Galli S, Ravagnani MP, Teruzzi G, Calligaris G, Gili S, Caputi L, Troiano S, Del Maso R, Trabattoni D. Transradial/brachial carotid artery stenting with proximal protection: technical instructions, acute results and long-term outcomes. Minerva Cardiol Angiol 2022; 70:765-777. [PMID: 36519647 DOI: 10.23736/s2724-5683.22.06223-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the feasibility, safety and efficacy of transradial/brachial (TR/TB) carotid artery stenting (CAS) with proximal cerebral protection (PCP) as a first line of treatment of carotid artery stenosis. METHODS Among 556 patients with significant (>50% if symptomatic or >70% if asymptomatic by Doppler US) unilateral, lipid-rich carotid artery stenosis undergoing TR/TB CAS, 137 (24.5%) deemed at high-risk for periprocedural cerebral embolization were scheduled for PCP with Mo.MA Ultra or Mo.MA mono-balloon. In patients with very complex anatomy the standard technique was modified loading the Mo.MA catheter without mandrel on two-wire system (so called 'No MAndrel 2 wire' technique, No.MA2) to increase support and deliverability. Device, technical and procedural successes both acute and at follow-up were the main outcomes. RESULTS Mean patients' age was 74±7 years (93% male), 15% were symptomatic and 59.6% owned 'high-surgical-risk' features. Stenosis degree was 85±7% with soft composition in all (by CT-angiography). TR and TB approach were selected in 92 (67%) and 45 (33%) patients, respectively. Target carotid axes were right, left bovine and left non bovine in 55%, 38% and 7% of patients. Procedures were successfully completed in all patients (intention-to-treat basis) with the standard Mo.MA Ultra system in 129 patients and the Mo.MA mono-balloon in 8 patients. No.MA2 technique was succesfully used in 16 patients as 'bailout' and in 27 patients as 'first line'). Device and technical success was 97% (133/137 patients) due to crossover to femoral access in 3 cases, and Mo.MA too short to engage the ECA in 1 patient. The procedural success was 96.7% (131/137, two minor strokes). Procedural time and fluoroscopy time were increased with No.MA2 technique. One major vascular complication occurred, in the TB group, while chronic radial occlusion was detected by Doppler ultrasound in 7/92 patients (7.1%) at 372±163 days of follow-up. The event-free survival was 91% and the stroke rate was 0%. CONCLUSIONS TR/TB CAS with proximal protection is a feasible, safe and effective strategy and may be considered a first line strategy in all comer patients.
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Affiliation(s)
- Piero Montorsi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy - .,Centro Cardiologico Monzino IRCCS, Milan, Italy -
| | | | | | | | | | | | - Luigi Caputi
- Division of Neurology, ASST Crema, Crema, Cremona, Italy
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Giang NL, Cuong TC, Thang LM, Tuan NM, Huy NDN, Linh DH, Muong MV, Thang DD, Trang NV, Duc NM. Transcervical approach for carotid artery stenting without flow reversal: A case report. Radiol Case Rep 2022; 17:4115-4119. [PMID: 36065238 PMCID: PMC9439964 DOI: 10.1016/j.radcr.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Current treatment options for high-risk patients with severe carotid artery stenosis include transcarotid artery revascularization, transfemoral carotid artery stenting, and carotid endarterectomy. Transfemoral carotid artery stenting is associated with high perioperative stroke risk, and recent studies and trials have identified transcarotid artery revascularization as a new technique able to minimize the stroke risk associated with high-risk procedures. Moreover, the transcervical approach allows easy access to the carotid artery in cases with an anatomically tortuous aortic arch. Therefore, determining the optimal approach to achieve arterial access during carotid stenting is important for successful procedures and positive outcomes. We report a clinical case of ischemic stroke due to severe stenosis of the left internal carotid artery indicated for stent deployment. After transfemoral carotid artery stenting failure, the patient's symptoms progressed from minor stroke to hemiplegia and Broca's aphasia. The transcervical approach was used to perform transcarotid artery revascularization after several days. The procedure was both safe and prevented recurrent stroke occurrence. Although transfemoral access is the classic approach used for carotid stenting, the transcervical approach can be used as an alternative and safe choice in cases with complex vascular anatomy, such as the one described here.
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10
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Shaban M, Budhathoki P, Lee S, Bhatt T, Rodriguez Guerra MA, Zaw M. Bovine Aortic Arch, A High-Risk Variant. Cureus 2022; 14:e25456. [PMID: 35774710 PMCID: PMC9239556 DOI: 10.7759/cureus.25456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/06/2022] Open
Abstract
The bovine aortic arch is a vascular variant related to an increased incidence of vascular and neurological complications. It should be ruled out in patients with vague neurological symptoms without a clear etiology. Our case is of a 72-year-old female patient who presented with a syncopal episode; the workup incidentally showed the aortic arch bovine variant with evidence of ischemic white matter disease more than expected for age. After reviewing the related literature, we suggest that this aortic variant is likely an independent risk factor for multiple vascular complications. A close follow-up is essential, and screening should be considered for symptomatic family members.
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Tsiouris C, Lazaridis N, Piagkou M, Duparc F, Antonopoulos I, Antonitsis P, Natsis K. The left-sided aortic arch variants: prevalence meta-analysis of imaging studies. Surg Radiol Anat 2022; 44:673-688. [PMID: 35486163 DOI: 10.1007/s00276-022-02945-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To estimate the prevalence of the left-sided aortic arch (LSAA) variants, and the effect of possible moderators on variants' detection. METHODS A systematic online literature search was conducted. The pooled prevalence with 95% confidence intervals was estimated for the typical and atypical branching patterns to compare the overall proportions of different variants. Meta-regression analyses were performed to investigate the effect of the subjects' gender and geographical region, and the multidetector computed tomography (MDCT) scanner's technology on the estimated prevalence. RESULTS In total, 18,075 cases from 23 imaging studies were included and 33 different LSAA variants were detected. The estimated heterogeneity was statistically significant. Based on the estimated prevalence, approximately 77% of the population is expected to have the typical branching anatomy with sequence brachiocephalic trunk-left common carotid artery-left subclavian artery, and 23% variant branching patterns. Approximately 71%, 23%, 2%, and 0.1% of the atypical populations are expected to have two, four, three, and five emerging branches, respectively. The meta-regression analyses showed that the number of detector rows of the MDCT scanner, and the subjects' geographical region are statistically significant moderators of the estimated prevalence. CONCLUSION The current findings indicate that the prevalence of the LSAA variant branching anatomy is significantly affected by the subjects' geographical region and the MDCT scanner's technological improvement, with the advanced scanners to facilitate the detection of the aortic arch variants. However, due to the heterogeneity among studies, further research is required.
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Affiliation(s)
- Christos Tsiouris
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Lazaridis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloníki, Greece.
| | - Maria Piagkou
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fabrice Duparc
- Laboratory of Anatomy, Faculty of Medicine-Pharmacy, Rouen-Normandy University, Rouen, France
| | - Ioannis Antonopoulos
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Polychronis Antonitsis
- Cardiothoracic Department, AHEPA University General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloníki, Greece
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12
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Comparison of transcarotid artery revascularization and transfemoral carotid artery stenting based on high risk anatomic characteristics. Ann Vasc Surg 2022; 87:21-30. [DOI: 10.1016/j.avsg.2022.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 11/22/2022]
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13
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Colombi D, Bodini FC, Morelli N, Ciatti C, Maniscalco P, Michieletti E. Predictors of the multiwire technique use in carotid artery stenting. Eur J Radiol 2021; 147:110120. [PMID: 34974365 DOI: 10.1016/j.ejrad.2021.110120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The multiwire technique (MWT) in carotid artery stenting (CAS), characterized by the use of more than one guidewire to support guiding catheter in patients with hostile neck anatomy, increases procedural time, enhancing the risk of periprocedural stroke. The aim of the present study was to identify which factors are predictors of the MWT use in CAS, in order to stratify patients with longer procedure at potential higher risk of periprocedural stroke. METHODS The study retrospectively included patients who underwent CAS for stenotic plaque between January 2015 and December 2019. Exclusion criteria was incomplete clinical data. For each patients were registered clinical data, main aortic arch and supra-aortic vessel anatomical features, carotid plaque characteristics, and procedural details. The sample was divided in two group on the basis of the number of guides used during the stenting procedure: one guide (standard technique, ST) or more than one guidewire (MWT) to support the guiding catheter. Differences between groups were tested by Chi-square text or Fisher's exact test and Mann-Whitney U test. Logistic regression analysis was used to identify predictors for the use of the MWT. The area under the ROC (AUC) curve was used to assess performance of the model to predict the use of the multiwire technique. RESULTS The final sample included 146 of the 204 (71%) patients who underwent CAS during the study period. The median age of the patients was 79 years (IQR 71-83 years) with 47/146 (32%) females. CAS was performed with MWT in 17/146 (12%) of the cases. MWT was used more likely in patients with aortic arch type II or III as compared to ST (71% vs 37%, P = 0.02) while plaques with heavy concentric calcifications were more frequent in ST as compared to MWT (38% vs 12%, P = 0.03). At multivariable analysis aortic arch type II or III (OR 5.08, 95% CI 1.48-17.93, P < 0.01), plaque stenosis > 79% (OR 4.13, 95% CI 1.03-16.61, P = 0.04), and plaque heavy concentric calcifications (OR 0.19, 95% CI 0.04-0.94, P = 0.04) were independent predictors of MWT use. The model showed an AUC of 0.827 (95% CI 0.756-0.884) for the prediction of the MWT use during CAS. CONCLUSIONS Aortic arch type II or III, carotid plaque with stenosis higher than 79% of the lumen or without heavy concentric calcifications were predictors for the use of the MWT during CAS. These features should be considered during planning of CAS as hallmark of vascular stiffness and therefore of higher procedure complexity.
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Affiliation(s)
- Davide Colombi
- Department of Radiological Functions, Radiology Unit, "Guglielmo da Saliceto" Hospital, Via Taverna 49, 29121, Piacenza, Italy (IT).
| | - Flavio Cesare Bodini
- Department of Radiological Functions, Radiology Unit, "Guglielmo da Saliceto" Hospital, Via Taverna 49, 29121, Piacenza, Italy (IT).
| | - Nicola Morelli
- Department of Radiological Functions, Radiology Unit, "Guglielmo da Saliceto" Hospital, Via Taverna 49, 29121, Piacenza, Italy (IT).
| | - Corrado Ciatti
- Orthopedics and Traumatology Department, "Guglielmo da Saliceto" Hospital, Via Taverna 49, 29121, Piacenza, Italy (IT).
| | - Pietro Maniscalco
- Orthopedics and Traumatology Department, "Guglielmo da Saliceto" Hospital, Via Taverna 49, 29121, Piacenza, Italy (IT).
| | - Emanuele Michieletti
- Department of Radiological Functions, Radiology Unit, "Guglielmo da Saliceto" Hospital, Via Taverna 49, 29121, Piacenza, Italy (IT).
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14
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Voss S, Campanella C, Burri M, Trenkwalder T, Sideris K, Erlebach M, Ruge H, Krane M, Vitanova K, Lange R. Anatomical reasons for failure of dual-filter cerebral embolic protection application in TAVR: A CT-based analysis. J Card Surg 2021; 36:4537-4545. [PMID: 34580919 DOI: 10.1111/jocs.16025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/06/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The dual-filter Sentinel™ Cerebral Protection System (Sentinel-CPS) is increasingly used during transcatheter aortic valve replacement (TAVR). However, complex vascular anatomy may challenge Sentinel-CPS deployment. AIM OF THE STUDY We sought to investigate the impact of anatomic features of the aortic arch and the supra-aortic arteries on technical device failure of Sentinel-CPS application. METHODS Analysis of the multislice computed tomography pre-TAVR aortograms of all patients undergoing TAVR with Sentinel-CPS between 2016 and 2020 (n = 92) was performed. We investigated the impact of aortic arch anatomy, configuration, and the angles of the supra-aortic arteries, including the determination of vascular tortuosity index on device failure of Sentinel-CPS application. RESULTS The Sentinel-CPS was applied successfully in 83 patients (90.2%). Device failure in nine patients (9.8%) was due to the infeasibility to perform correct deployment of both filters (n = 7) and to obtain peripheral radial access (n = 2). Patients with a failure of Sentinel-CPS application had a higher right subclavian tortuosity index (217 [92-324] vs. 150 [42-252], p = .046), a higher brachiocephalic tortuosity index (27 [5-51] vs. 10 [0-102], p = 0.033) and a larger angulation of the brachiocephalic artery (59° [22-80] vs. 39° [7-104], p = .014) compared with patients with successful application. A brachiocephalic angle more than 59° was predictive for device failure. No differences in aortic arch anatomy or common carotid artery tortuosity were detected between the groups. CONCLUSIONS Brachiocephalic tortuosity was found to be associated with failure of Sentinel-CPS application. Filter-based usage should be avoided in TAVR patients with a brachiocephalic angle more than 59°.
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Affiliation(s)
- Stephanie Voss
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Caterina Campanella
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Teresa Trenkwalder
- Klinik für Herz- und Kreislauferkrankungen, German Heart Centre Munich, Technical University Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research) - Partner Site Munich Heart Alliance, Munich, Germany
| | - Konstantinos Sideris
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Magdalena Erlebach
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Markus Krane
- Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Keti Vitanova
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Centre Munich, Technical University Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research) - Partner Site Munich Heart Alliance, Munich, Germany
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15
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Mantri SS, Raju B, Jumah F, Rallo MS, Nagaraj A, Khandelwal P, Roychowdhury S, Kung D, Nanda A, Gupta G. Aortic arch anomalies, embryology and their relevance in neuro-interventional surgery and stroke: A review. Interv Neuroradiol 2021; 28:489-498. [PMID: 34516323 PMCID: PMC9326868 DOI: 10.1177/15910199211039924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Congenital aortic arch anomalies are commonly encountered during neurointerventional procedures. While some anomalies are identified at an early age, many are incidentally discovered later in adulthood during endovascular evaluations or interventions. Proper understanding of the normal arch anatomy and its variants is pivotal to safely navigate normal aortic arch branches and to negotiate the catheter through anomalies during neurointerventional procedures. This is particularly relevant in the increasingly "transradial first" culture of neurointerventional surgery. Moreover, some of these anomalies have a peculiar predilection for complications including aneurysm formation, dissection, and rupture during the procedure. Therefore, an understanding of these anomalies, their underlying embryological basis and associations, and pattern of circulation will help endovascular neurosurgeons and interventional radiologists navigate with confidence and consider relevant pathologic associations that may inform risk of cerebrovascular disease. METHODS Here, we present a brief review of the basic embryology of the common anomalies of the aortic arch along with their neurological significances and discuss, through illustrative cases, the association of aortic arch anomalies with cerebral vascular pathology. CONCLUSIONS Understanding the aortic arch anomalies and its embryological basis is essential to safely navigate the cerebral vascular system during neurointerventional surgeries.
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Affiliation(s)
- Shilpa S Mantri
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Bharath Raju
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Fareed Jumah
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Michael S Rallo
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Anmol Nagaraj
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Priyank Khandelwal
- Department of Neurosurgery, 242612New Jersey Medical School & University Hospital, USA
| | - Sudipta Roychowdhury
- Department of Neuroradiology, 12287 Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - David Kung
- Department of Neurosurgery, 242612New Jersey Medical School & University Hospital, USA
| | - Anil Nanda
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Gaurav Gupta
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
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16
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Onrat E, Uluışık IE, Ortug G. The left vertebral artery arising directly from the aortic arch. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Marrocco-Trischitta MM, Alaidroos M, Romarowski RM, Milani V, Ambrogi F, Secchi F, Glauber M, Nano G. Aortic arch variant with a common origin of the innominate and left carotid artery as a determinant of thoracic aortic disease: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 57:422-427. [PMID: 31620770 DOI: 10.1093/ejcts/ezz277] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/29/2019] [Accepted: 09/16/2019] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to investigate whether the 'bovine' arch [i.e. arch variant with a common origin of the innominate and left carotid artery (CILCA)] is associated with an increased risk of thoracic aortic disease (TAD). The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, EMBASE and Cochrane databases were searched to identify all case series reporting about CILCA arch and TAD between January 2008 and December 2018. A total of 485 studies were screened. The prevalence of CILCA arch was assessed, and data analysis was performed considering the difference in the risk of TAD for presence versus absence of CILCA arch. Eight studies enrolling 11 381 subjects were retrieved for quantitative analysis. The proportion of TAD among CILCA arch patients was higher [41.5% (28.1-56.4)] than the proportion among patients with standard arch configuration 34.0% (20.1-51.4). The odds ratio of developing TAD was 1.4 times higher in subjects with CILCA arch (95% confidence interval 1.068-1.839). The test for an overall effect indicated a significant association between CILCA arch and TAD (P < 0.015). The I2 was 78.1% with a value of P < 0.001 for heterogeneity. The Egger test did not show evidence of publication bias (P = 0.317). In conclusion, our meta-analysis supports the hypothesis of a correlation between the presence of CILCA arch and the onset of TAD. Our results warrant a specific and long-term surveillance for patients with this anatomical variant, and a thorough awareness of its potential clinical implications during image interpretation.
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Affiliation(s)
- Massimiliano M Marrocco-Trischitta
- Clinical Research Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy.,Vascular Surgery Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy
| | - Moad Alaidroos
- Clinical Research Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy.,Vascular Surgery Unit, Policlinico San Marco, Zingonia, Italy
| | - Rodrigo M Romarowski
- 3D and Computer Simulation Laboratory, IRCCS - Policlinico San Donato, Milan, Italy
| | - Valentina Milani
- Biostatistics Service, IRCCS - Policlinico San Donato, Milan, Italy
| | - Federico Ambrogi
- Biostatistics Service, IRCCS - Policlinico San Donato, Milan, Italy
| | - Francesco Secchi
- Division of Radiology, IRCCS - Policlinico San Donato, Milan, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Department, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy.,Department of "Scienze Biomediche per la Salute", University of Milan, Milan, Italy
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18
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Montorsi P, Cortese B, Cernetti C, Lanzellotti D, Di Palma G, Marchese A, Cremonesi A. Transradial approach for carotid artery stenting: A position paper from the Italian Society of Interventional Cardiology (SICI-GISE). Catheter Cardiovasc Interv 2021; 97:1440-1451. [PMID: 33844439 DOI: 10.1002/ccd.29677] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/14/2021] [Accepted: 03/19/2021] [Indexed: 12/24/2022]
Abstract
Carotid artery stenting (CAS) is a valid and effective alternative to endoatherectomy when performed by experienced operators. The conventional approach used is the transfemoral one, but in the last 10 years a transradial (TR) approach, the standard access for cardiac catheterization, became widely adopted for peripheral vascular interventions, included the extracranial carotids. Preliminary experiences suggest this approach as safe and effective, especially in specific anatomical and clinical settings that have been shown to be associated with high risk of complications from the femoral route. Lacking international guidelines, this document, promoted by the Italian Society of Interventional Cardiology - Gruppo Italiano Studi Emodinamici (SICI-GISE), was drawn-up by a panel of interventional cardiologists with a documented experience on the subject, focusing on the indications, techniques and materials that should be used for this type of intervention and the most recent literature on the subject.
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Affiliation(s)
- Piero Montorsi
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Bernardo Cortese
- Cardiovascular Research Team, Fondazione Ricerca e Innovazione Cardiovascolare, San Carlo Clinic, Paderno Dugnano-Milano, Italy
| | - Carlo Cernetti
- U.O.C. Cardiologia, Ospedale San Giacomo, Castelfranco Veneto, Treviso, Italy
| | - Davide Lanzellotti
- U.O.C. Cardiologia, Ospedale San Giacomo, Castelfranco Veneto, Treviso, Italy
| | - Gaetano Di Palma
- Cardiovascular Research Team, Fondazione Ricerca e Innovazione Cardiovascolare, San Carlo Clinic, Paderno Dugnano-Milano, Italy
| | - Alfredo Marchese
- U.O.C. Cardiologia Interventistica, Anthea Hospital-GVM Care & Research, Bari, Italy
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19
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Kitamura Y, Sakata H, Ezura M, Ishida T, Endo H, Inoue T, Tominaga T. Carotid artery stenting in a patient with an incidentally found double aortic arch: A case report. Interv Neuroradiol 2021; 27:722-726. [PMID: 33673756 DOI: 10.1177/15910199211001717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Double aortic arch is a type of congenital vascular ring, which rarely presents in adults. Herein, we report a case of carotid artery stenting (CAS) accompanied by an incidentally found double aortic arch. A 77-year-old man presented with bilateral severe carotid artery stenosis. The patient underwent truncal 3D-computed tomography angiography (CTA) to evaluate the access route before CAS, which lead to the diagnosis of an asymptomatic double aortic arch. Referring to the 3D-CTA images, a guiding catheter was successfully navigated to the targeted common carotid artery via the transfemoral approach despite the challenging, complex anatomy of the aortic arch. CAS was performed in both carotid arteries under distal balloon protection, without any neurological deficits. Considering the possible presence of anatomical variants such as double aortic arch, preoperative evaluation of the access route would be efficient for prospective CAS patients.
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Affiliation(s)
- Yuki Kitamura
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Hiroyuki Sakata
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Masayuki Ezura
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Tomohisa Ishida
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Hidenori Endo
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Takashi Inoue
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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20
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Natsis K, Piagkou M, Lazaridis N, Kalamatianos T, Chytas D, Manatakis D, Anastasopoulos N, Loukas M. A systematic classification of the left-sided aortic arch variants based on cadaveric studies' prevalence. Surg Radiol Anat 2021; 43:327-345. [PMID: 33386933 DOI: 10.1007/s00276-020-02625-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Typical branching pattern of the left-sided aortic arch consists of the brachiocephalic trunk (BCT), the left common carotid artery (LCCA) and the left subclavian artery (LSA). Variant patterns have been associated with a broad spectrum of pathologies. The meticulous knowledge of potential aortic arch variants is of utmost importance to radiologists, interventional cardiologists, vascular and thoracic surgeons. The current systematic review collects all aortic arch branching patterns and their frequency as published by various cadaveric studies, calculates prevalence taking into account the gender and the different people background, as well. All extracted variant patterns are classified into types and subtypes according to the number of emerging (major and minor) branches (1, 2, 3, 4 and 5) and to the prevalence they appear. In cases of similar prevalence, total cases were taken into consideration; otherwise the variants were classified under the title "other rare variants". METHODS A systematic online search of PubMed and Google books databases was performed only in cadaveric studies. RESULTS Twenty studies with typical (78% prevalence) and variable (22%) branching patterns were included. Types 3b, 2b, 4b, 1b and 5b had a prevalence of 81%, of 13%, of 5%, 0% and of 0%, respectively. Common variants were the brachiocephalico-carotid trunk (BCCT, 49% prevalence), the aberrant left vertebral artery (LVA, 41%) and the aberrant right subclavian artery (ARSA, 8%). LVA of aortic origin was detected in 32%, the bicarotid trunk (biCT) in 5% and the bi-BCT trunk in 3%. Thyroidea ima artery, a minor branch emerging from the aortic arch was found in 2%. Coexisted variants were detected in 4% (ARSA with a distinct RCCA and LCCA origin), in 3% (BCCT with a LVA of aortic origin), in 2% (ARSA with a biCT and a vertebrosubclavian trunk). CONCLUSION No significant gender or ethnic differences exist among the 5 branching types. The proposed classification scheme aims to become a valuable and easy to use tool in the hands of all physicians involved in diagnosis and treatment of aortic arch pathology. It could be also useful in anatomical education, as well.
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Affiliation(s)
- K Natsis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloníki, Greece.
| | - M Piagkou
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - N Lazaridis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloníki, Greece
| | - T Kalamatianos
- Hellenic Center for Neurosurgical Research "Petros Kokkalis", Athens, Greece
| | - D Chytas
- Medical School, European University of Cyprus, 6, Diogenous Str, 2404, Nicosia, Cyprus
| | - D Manatakis
- Department of Surgery, Konstantopouleio General Hospital, Nea Ionia, 14233, Athens, Greece
| | - N Anastasopoulos
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124, Thessaloníki, Greece
| | - M Loukas
- Department of Anatomical Sciences, School of Medicine, St George's University, Saint George's, Grenada
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21
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Feasibility and Safety of Cerebral Embolic Protection Device Insertion in Bovine Aortic Arch Anatomy. J Clin Med 2020; 9:jcm9124118. [PMID: 33419286 PMCID: PMC7766100 DOI: 10.3390/jcm9124118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Cerebral embolic protection devices (CEPDs) have emerged as a mechanical barrier to prevent debris from reaching the cerebral vasculature, potentially reducing stroke incidence. Bovine aortic arch (BAA) is the most common arch variant and represents challenge anatomy for CEPD insertion during transcatheter aortic valve replacement (TAVR). Methods: Cohort study reporting the SentinelTM Cerebral Protection System insertion’s feasibility and safety in 165 adult patients submitted to a transfemoral TAVR procedure from April 2019 to April 2020. Patients were divided into 2 groups: (1) BAA; (2) non-BAA. Results: Median age, EuroScore II, and STS score were 79 years (74–84), 2.9% (1.7–6.2), and 2.2% (1.6–3.2), respectively. BAA was present in 12% of cases. Successful two-filter insertion was 86.6% (89% non-BAA vs. 65% BAA; p = 0.002), and debris was captured in 95% (94% non-BAA vs. 95% BAA; p = 0.594). No procedural or vascular complications associated with Sentinel insertion and no intraprocedural strokes were reported. There were two postprocedural non-disabling strokes, both in non-BAA. Conclusion: This study demonstrated Sentinel insertion feasibility and safety in BAA. No procedural and access complications related to Sentinel deployment were reported. Being aware of the bovine arch prevalence and having the techniques to navigate through it allows operators to successfully use CEPDs in this anatomy.
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22
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Plant S, Patel BM. Direct Common Carotid Artery Puncture for Endovascular Treatment of Acute Large Vessel Ischemic Stroke in a Patient With Congenital Rare Variant of the Great Vessels. Cureus 2020; 12:e11127. [PMID: 33240720 PMCID: PMC7682920 DOI: 10.7759/cureus.11127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This report describes a case of acute left middle cerebral artery ischemic stroke that occurred in a patient with unique anatomy of the vessels arising from the aortic arch that remained undiagnosed until the age of 36. The nature of the anatomical variance proved problematic in establishing access to the carotid artery via traditional transfemoral or transbrachial approaches, and direct access was established via left carotid puncture. The patient regained substantial neurologic function. The direct carotid approach described below serves as a viable alternate route to establishing reperfusion in patients with complex or problematic aortic arch anatomy.
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Affiliation(s)
- Samuel Plant
- Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Biraj M Patel
- Neurointerventional Surgery, Carilion Clinic, Roanoke, USA
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23
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Kang J, Kim YW, Kim DI, Woo SY, Park YJ. Outcomes of Carotid Revascularization versus Optimal Medical Treatment Alone for Asymptomatic Carotid Stenosis: Inverse-Probability-of-Treatment Weighting Using Propensity Scores. World Neurosurg 2020; 146:e419-e430. [PMID: 33223129 DOI: 10.1016/j.wneu.2020.10.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The benefits and necessity of revascularization for asymptomatic carotid stenosis remains under debate. This study aimed to determine the more durable and beneficial alternative between carotid revascularization and optimal medical treatment (OMT) alone for asymptomatic carotid stenosis. METHODS We performed a retrospective analysis of patients with asymptomatic severe carotid stenosis at a tertiary institution between 1994 and 2017. We compared revascularization (carotid endarterectomy [CEA] and carotid artery stenting [CAS]) with OMT alone by using inverse-probability-of-treatment weighting with propensity scores to account for selection bias. The primary end point was a composite of any stroke, myocardial infarction, and death within 30 days, plus ipsilateral stroke thereafter. RESULTS A total of 1089 patients were included in the analysis (56% CEA, 25% CAS, 19% OMT alone). Patients who underwent CAS consistently showed greater risk regarding the primary composite end point compared with those who received OMT alone (hazard radio [HR] 3.32, 95% confidence interval 1.014-10.868; P = 0.047), but the CEA group showed no significant difference (HR 1.19, 95% confidence interval 0.385-4.584; P = 0.761). The CAS group had the greatest rates of any stroke within 30 days (4.0%, P = 0.0006) and ipsilateral stroke thereafter (3.68%, P = 0.0009). There was no death within 30 days. In the long-term outcomes, neither CEA nor CAS showed significant differences in HR compared with OMT alone. CONCLUSIONS Our study suggests that for stroke prevention in asymptomatic severe carotid stenosis, CAS might be inferior to the other 2 options regarding early outcomes. However, further investigation is required regarding the efficacy and durability of OMT alone.
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Affiliation(s)
- Jihee Kang
- Division of Vascular Surgery, Department of Surgery, Inha University Hospital, Inha University School of Medicine, Joong-gu, Incheon, South Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seodaemun-gu, Seoul, South Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Shin-Young Woo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea.
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24
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Casana R, Bissacco D, Malloggi C, Tolva VS, Odero A, Domanin M, Trimarchi S, Silani V, Parati G. Aortic arch types and postoperative outcomes after carotid artery stenting in asymptomatic and symptomatic patients. INT ANGIOL 2020; 39:485-491. [PMID: 33086779 DOI: 10.23736/s0392-9590.20.04494-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to investigate the influence of the aortic arch type on technical and clinical success of carotid artery stenting (CAS) procedure. METHODS Clinical and anatomical data of consecutive patients who underwent CAS from 2010 to 2018 were prospectively collected and retrospectively analyzed. Primary outcome was technical success, define as successful stent delivery and deployment and <30% residual carotid stenosis. Secondary outcomes were death, stroke, myocardial infarction (MI) and transient ischemic attack (TIA) rates at 30 days after CAS. Subgroups analysis with asymptomatic and symptomatic patients were also performed. RESULTS During the study period, 523 patients were enrolled and analyzed. Among these, 176 (33.6%) had Type I, 227 (43.4%) had Type II and 120 (23.0%) had Type III or bovine aortic arch (BAA) type. Technical success rate was achieved in 96.0% of cases. At 30 days, if compared with Type I or II, patient with Type III or BAA experienced a higher death rate (0 vs. 0 vs. 1.8%, respectively; P=0.056) and combined postoperative stroke/TIA rate (3% vs. 2.8% vs. 9.9%, respectively; P=0.012). No differences for same outcomes between asymptomatic and symptomatic patients were described, although the latter group experienced more postoperative MI. A multivariate analysis revealed Type III or BAA as an independent risk factor for postoperative stroke/TIA (HR 3.23, IC95% 1.40-7.45; P=0.006). CONCLUSIONS In this cohort of patients, death and postoperative neurological complications rates were associated with Type III or BAA, irrespective of symptomatic patients' status. Extremely attention is required during perioperative period in patients who were candidate to CAS and with challenging aortic arch anatomy.
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Affiliation(s)
- Renato Casana
- Istituto Auxologico Italiano IRCCS, Department of Surgery, Milan, Italy - .,Istituto Auxologico Italiano IRCCS, Laboratory of Research in Vascular Surgery, Milan, Italy -
| | - Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Malloggi
- Istituto Auxologico Italiano IRCCS, Laboratory of Research in Vascular Surgery, Milan, Italy
| | - Valerio S Tolva
- Department of Vascular and Endovascular Surgery, Policlinico di Monza, Monza, Italy
| | - Andrea Odero
- Istituto Auxologico Italiano IRCCS, Department of Surgery, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, IRCCS Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Santi Trimarchi
- Vascular Surgery Unit, IRCCS Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- Istituto Auxologico Italiano IRCCS, Department of Neurology-Stroke and Neuroscience, Ospedale San Luca, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Milan, Italy.,Department of Medicine and Surgery, Università di Milano-Bicocca, Monza, Italy
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Bedayat A, Jalili MH, Hassani C, Chalian H, Reuhm S, Moriarty J. CT evaluation of unrepaired/incidental congenital cardiovascular diseases in adults. Diagn Interv Imaging 2020; 102:213-224. [PMID: 34102129 DOI: 10.1016/j.diii.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022]
Abstract
Congenital heart disease (CHD) affects approximately one million people in the USA with the number increasing by 5% each year. Patients are usually both diagnosed and treated in infancy, however many of them may have subclinical CHD that remains undiagnosed until late adulthood. Patients with complex CHD tend to be symptomatic and are diagnosed at a younger age than those with a single defect. CHDs can be divided into three categories, including cardiac, great vessels and coronary artery anomalies. Recent advances in computed tomography (CT) technology with faster acquisition time and improved spatial resolution allow for detailed evaluation of cardiac morphology and function. The concomitant increased utilization of CT has simultaneously led to more sensitive detection and more thorough diagnosis of CHD. Recognition of and understanding the imaging attributes specific to each anomaly is important for radiologists in order to make a correct and definite diagnosis. This article reviews the spectrum of CHDs, which persist into adulthood that may be encountered by radiologists on CT.
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Affiliation(s)
- Arash Bedayat
- Department of Radiological Sciences, Thoracic and Diagnostic Cardiovascular Imaging, David Geffen School of Medicine, 90095 Los Angeles, CA, USA.
| | - Mohammad H Jalili
- Department of Radiological Sciences, Thoracic and Diagnostic Cardiovascular Imaging, David Geffen School of Medicine, 90095 Los Angeles, CA, USA
| | - Cameron Hassani
- Department of Radiological Sciences, Thoracic and Diagnostic Cardiovascular Imaging, David Geffen School of Medicine, 90095 Los Angeles, CA, USA
| | - Hamid Chalian
- Department of Radiology, Duke University Medical Center, 27710 Durham, NC, USA
| | - Stefan Reuhm
- Department of Radiological Sciences, Thoracic and Diagnostic Cardiovascular Imaging, David Geffen School of Medicine, 90095 Los Angeles, CA, USA
| | - John Moriarty
- Department of Radiological Sciences, Thoracic and Diagnostic Cardiovascular Imaging, David Geffen School of Medicine, 90095 Los Angeles, CA, USA
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Risk Factors of Cerebellar Microembolic Infarctions After Carotid Artery Stenting. World Neurosurg 2020; 142:e290-e296. [DOI: 10.1016/j.wneu.2020.06.207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/28/2022]
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Feddal A, Escalard S, Delvoye F, Fahed R, Desilles JP, Zuber K, Redjem H, Savatovsky JS, Ciccio G, Smajda S, Ben Maacha M, Mazighi M, Piotin M, Blanc R. Fusion Image Guidance for Supra-Aortic Vessel Catheterization in Neurointerventions: A Feasibility Study. AJNR Am J Neuroradiol 2020; 41:1663-1669. [PMID: 32819903 DOI: 10.3174/ajnr.a6707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/03/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular navigation through tortuous vessels can be complex. Tools that can optimise this access phase need to be developed. Our aim was to evaluate the feasibility of supra-aortic vessel catheterization guidance by means of live fluoroscopy fusion with MR angiography or CT angiography. MATERIALS AND METHODS Twenty-five patients underwent preinterventional diagnostic MRA, and 8 patients underwent CTA. Fusion guidance was evaluated in 35 sessions of catheterization, targeting a total of 151 supra-aortic vessels. The time for MRA/CTA segmentation and fluoroscopy with MRA/CTA coregistration was recorded. The feasibility of fusion guidance was evaluated by recording the catheterizations executed by interventional neuroradiologists according to a standard technique under fluoroscopy and conventional road-mapping independent of the fusion guidance. Precision of the fusion roadmap was evaluated by measuring (on a semiquantitative 3-point scale) the maximum offset between the position of the guidewires/catheters and the vasculature on the virtual CTA/MRA images. The targeted vessels were divided in 2 groups according to their position from the level of the aortic arch. RESULTS The average time needed for segmentation and image coregistration was 7 ± 2 minutes. The MRA/CTA virtual roadmap overlaid on live fluoroscopy was considered accurate in 84.8% (128/151) of the assessed landmarks, with a higher accuracy for the group of vessels closer to the aortic arch (92.4%; OR, 4.88; 95% CI, 1.83-11.66; P = .003). CONCLUSIONS Fluoroscopy with MRA/CTA fusion guidance for supra-aortic vessel interventions is feasible. Further improvements of the technique to increase accuracy at the cervical level and further studies are needed for assessing the procedural time savings and decreasing the x-ray radiation exposure.
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Affiliation(s)
- A Feddal
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Escalard
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - F Delvoye
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - R Fahed
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J P Desilles
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - K Zuber
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - H Redjem
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J S Savatovsky
- Diagnostic Neuroradiology Unit (J.S.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - G Ciccio
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Smajda
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Ben Maacha
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Mazighi
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - M Piotin
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - R Blanc
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
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The Relation Between Aortic Arch Branching Types and the Laterality of Cardio-Embolic Stroke. J Stroke Cerebrovasc Dis 2020; 29:104917. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/20/2020] [Accepted: 04/25/2020] [Indexed: 01/23/2023] Open
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Conway AM, Nguyen Tran NT, Qato K, Ehidom C, Stoffels GJ, Giangola G, Carroccio A. Complexity of Aortic Arch Anatomy Affects the Outcomes of Transcarotid Artery Revascularization Versus Transfemoral Carotid Artery Stenting. Ann Vasc Surg 2020; 67:78-89. [PMID: 32339690 DOI: 10.1016/j.avsg.2020.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transcarotid artery revascularization (TCAR) has been shown to have half the rates of transient ischemic attack (TIA), stroke, and death compared with transfemoral carotid artery stenting (TFCAS). Successful outcomes of TFCAS require careful patient selection. The aim of this study was to determine the outcomes of TFCAS versus TCAR in both simple (type I) and complex (type II and III) aortic arches. METHODS A retrospective cohort study was performed comparing the outcomes of patients undergoing TFCAS versus TCAR with simple and complex aortic arches using the Vascular Quality Initiative registry from August 2011 to May 2019. The primary outcome was a composite of in-hospital TIA/stroke/death. RESULTS About 6,108 carotid artery interventions were analyzed, including 3,536 (57.9%) patients with type I, 2,013 (33.0%) with type II, and 559 (9.2%) with type III aortic arch. In 3,535 patients with a simple arch, 1,917 underwent TFCAS and 1,619 had TCAR. Mean age was 70.6 (±9.5) years, and 2,382 (67.4%) patients were males. The primary outcome of postoperative TIA/stroke/death was seen significantly less frequently in those undergoing TCAR compared with TFCAS in simple arches (odds ratio [OR], 0.63; 95% confidence interval [95% CI], 0.43-0.94; P = 0.0236). Although the individual outcome of death occurred less often in TCAR (P = 0.0025), there was no difference in the occurrence of in-hospital stroke (P = 0.8836) or TIA (P = 0.4608). On multivariable analysis, TCAR was associated with improved outcomes (P = 0.0062). A worse outcome was associated with increasing age (P < 0.001), a prior stroke (P < 0.0001), and increasing number of stents (P = 0.0483). In 2,572 patients with a complex arch, 1,416 underwent TFCAS and 1,156 had TCAR. Mean age was 73.0 (±9.1) years, and 1,655 (64.4%) were males. In complex arch anatomy, the primary outcome of in-hospital TIA/stroke/death was seen significantly less frequently in TCAR compared with TFCAS (OR, 0.49; 95% CI, 0.31-0.77; P = 0.0022). Again noted was a significant difference in death, with better outcomes in TCAR (P = 0.0133). Although the occurrence of in-hospital TIA was no different between the 2 approaches (P = 0.6158), there were significantly fewer strokes in those treated with TCAR (P = 0.0132). TCAR (P = 0.0146) was associated with improved outcomes. A worse outcome was seen with advancing age (P = 0.0003), prior strokes (P = 0.01), and a left-sided lesion (P = 0.0176). CONCLUSIONS TCAR has improved outcomes of TIA/stroke/death compared with TFCAS in both simple and complex aortic arch anatomy. In simple aortic arches, there is no difference in neurologic outcomes between both approaches. In complex arch anatomy, TCAR has fewer strokes.
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Affiliation(s)
- Allan M Conway
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY.
| | - Nhan T Nguyen Tran
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Khalil Qato
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Clinton Ehidom
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | | | - Gary Giangola
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Alfio Carroccio
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
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Marrocco-Trischitta MM, Alaidroos M, Romarowski RM, Secchi F, Righini P, Glauber M, Nano G. Geometric Pattern of Proximal Landing Zones for Thoracic Endovascular Aortic Repair in the Bovine Arch Variant. Eur J Vasc Endovasc Surg 2019; 59:808-816. [PMID: 31889656 DOI: 10.1016/j.ejvs.2019.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/14/2019] [Accepted: 11/12/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim was to investigate whether the "bovine" aortic arch (i.e. arch variant with a common origin of the innominate and left carotid artery (CILCA)) is associated with a consistent geometric configuration of proximal landing zones for thoracic endovascular aortic repair (TEVAR). METHODS Anonymised thoracic computed tomography (CT) scans of healthy aortas were reviewed to retrieve 100 cases of CILCA. Suitable cases were stratified according to type 1 and 2 CILCA, and also based on type of arch (I, II, and III). Further processing allowed calculation of angulation and tortuosity of the proximal landing zones. Centre lumen line lengths of each proximal landing zone were measured in a view perpendicular to the centre line. All geometric features were compared with those measured in healthy patients with a standard arch configuration (n = 60). Two senior authors independently evaluated the CT scans, and intra- and interobserver repeatability were assessed. RESULTS The 100 selected patients (63% male) were 71.4 ± 7.7 years old. Type 1 CILCA (62/100) was more prevalent than type 2 CILCA (38/100), and the two groups were comparable in age (p = .11). Zone 3 presented a severe angulation (i.e. > 60°), which was greater than in Zone 2 (p < .001), and a consistently greater tortuosity than Zone 2 (p = .003). This pattern did not differ between type 1 and type 2 CILCA. A greater tortuosity was also observed in Zone 0, which was related to increased elongation of the ascending aorta (i.e. Zone 0), than the standard configuration. The CILCA had an overall greater elongation, and Zone 2 also was specifically longer. When stratifying by type of arch, reversely from Type III to Type I, the CILCA presented a gradual flattening of its transverse tract, which entailed a consistent progressive elongation (p = .03) and kinking of the ascending aorta, with a significant increase of Zone 0 angulation to even a severe degree (p = .001). Also, from Type III to Type I, Zone 2 presented a progressively shorter length (p = .004), which was associated with increased tortuosity (p < .05). Mean intra- and interobserver differences for angulation measurements were 1.4° ± 6.8° (p = .17) and 2.0° ± 10.1° (p = .19), respectively. CONCLUSION CILCA presents a consistent and peculiar geometric pattern compared with standard arch configuration, which provides relevant information for TEVAR planning, and may have prognostic implications.
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Affiliation(s)
- Massimiliano M Marrocco-Trischitta
- Clinical Research Unit, IRCCS - Policlinico San Donato, Milan, Italy; Vascular Surgery Unit, IRCCS - Policlinico San Donato, Milan, Italy.
| | - Moad Alaidroos
- Clinical Research Unit, IRCCS - Policlinico San Donato, Milan, Italy; Vascular Surgery Unit, Policlinico San Marco, Zingonia, Italy
| | - Rodrigo M Romarowski
- 3D and Computer Simulation Laboratory, IRCCS - Policlinico San Donato, Milan, Italy
| | - Francesco Secchi
- Division of Radiology, IRCCS - Policlinico San Donato, Milan, Italy; Department of "Scienze Biomediche per la Salute", University of Milan, Italy
| | - Paolo Righini
- Vascular Surgery Unit, IRCCS - Policlinico San Donato, Milan, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, IRCCS - Policlinico San Donato, Milan, Italy; Department of "Scienze Biomediche per la Salute", University of Milan, Italy
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Congenital Aplasia of the Common Carotid Artery: A Comprehensive Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9896138. [PMID: 31976332 PMCID: PMC6959148 DOI: 10.1155/2019/9896138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022]
Abstract
In an attempt to describe the morphofunctional consequences of uni- and bilateral aplasia of the common carotid artery (CCA), which is usually a vascular source of the external carotid (ECA) and internal carotid (ICA) arteries, we investigated online databases of anatomical and clinical papers published from the 18th century to the present day. We found 87 recorded cases of uni- and bilateral CCA aplasia in subjects from the first hours to the eighth decade of life, which had been discovered in 14 (known) countries. Four crucial parameters were described: the embryology of the carotid arteries, morphophysiology of the carotid arteries, CCA aplasia, and unilateral versus bilateral CCA aplasia, including history, general data, diagnosing, vascular sources, caliber, course of the separated ECA and ICA, associated vascular variants, and pathological disorders. To complete the knowledge of the morphofunctional consequences of the absence of some artery of the carotid system, and risking the possibility of repeating some words, as "carotid artery", or "carotid aplasia" and the headings from our previous article about bilateral ICA absence, this review is the first in the literature that recorded all cases of the CCA aplasia published and/or cited for the past 233 years. Main characteristic of the CCA absence is its association with 21 different diseases, among which the aneurysms were in 13.69% of cases, and 17.80% of cases were without pathology.
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Qiu Y, Wu X, Zhuang Z, Li X, Zhu L, Huang C, Zhuang H, Ma M, Ye F, Chen J, Wu Z, Yu X, An M, Chen R, Chen J, Guan L, Sang H, Ye Y, Han Y, Chen Z, Qin H, Zhu H, Zhou Y, Zilundu PLM, Xu D, Zhou L. Anatomical variations of the aortic arch branches in a sample of Chinese cadavers: embryological basis and literature review. Interact Cardiovasc Thorac Surg 2019; 28:622-628. [PMID: 30445440 DOI: 10.1093/icvts/ivy296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/10/2018] [Accepted: 09/22/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study is to determine the incidence and explore the types of aortic arch branch variations found in our cadavers. METHODS The types and incidence of aortic branch variations in 120 cadavers were analysed after careful dissection. RESULTS One hundred and six of 120 cadavers had normal aortic arch branches and gave rise to usual branches, namely the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. The remaining 14 cadavers had 2 basic types of branch variations, thus accounting for an incidence of 11.67%. A total of 9 aortic arches emitted 4 branches; the brachiocephalic trunk, the left common carotid artery, the left vertebral artery and the left subclavian artery (incidence 7.5%). The second subgroup of 5 cadavers also emitted 4 aortic branches: the right common carotid artery, the left common carotid artery, the left subclavian artery and the right subclavian artery (incidence 4.16%). In this group, the right subclavian artery sprung as a distal branch of the aortic arch (descending), thus making a vascular ring that takes a superoposterior course round the back of the trachea and the oesophagus to reach the right side. There was a single cadaver, different from the other 4 aortic branches of the second group which had a common origin for the common carotid arteries, while the left subclavian artery and distally placed right subclavian artery were present. We did not observe any Kommerell's aortic diverticula. CONCLUSIONS The variations of aortic arch branching are complex and diverse due to varied possible alterations in the embryological processes. There is an imperative need for further research on these variations to elucidate the possible relationships with clinical diagnostic or surgical events.
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Affiliation(s)
- Yumin Qiu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Xiaoxin Wu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Zhuokai Zhuang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Xiaozhi Li
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Lei Zhu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Cijun Huang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Hongjie Zhuang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Mingjian Ma
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Feng Ye
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Jing Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Zhiying Wu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Xiaopei Yu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Mingjie An
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Rui Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Junyu Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Lizhi Guan
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Hanyi Sang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Yuyang Ye
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Yueyin Han
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Zhuokai Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Han Qin
- Department of Cardiac Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Haoshuai Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Yingying Zhou
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China.,Department of Human Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Prince L M Zilundu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China.,Department of Human Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Dazheng Xu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China.,Department of Human Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Lihua Zhou
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China.,Department of Human Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
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A Clinical Validation Study of Anatomical Risk Scoring for Procedural Stroke in Patients Treated by Carotid Artery Stenting in the International Carotid Stenting Study. Eur J Vasc Endovasc Surg 2019; 58:664-670. [DOI: 10.1016/j.ejvs.2019.04.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/20/2019] [Accepted: 04/24/2019] [Indexed: 11/22/2022]
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Morosetti D, Di Stefano C, Mondillo M, Pensabene MC, De Corato L, Bizzaglia M, Di Martino A, Floris R. Right-sided aortic arch with mirror image branching and situs solitus: a case of a 79 years old woman. Radiol Case Rep 2019; 14:1246-1251. [PMID: 31462948 PMCID: PMC6706679 DOI: 10.1016/j.radcr.2019.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/21/2019] [Accepted: 07/28/2019] [Indexed: 11/29/2022] Open
Abstract
Right aortic arch with mirror image branching (RAMI) is a rare congenital defect of the aorta. The exact incidence of RAMI in the general population is unclear. In RAMI the first branch arising from the arch is the left innominate artery, followed by the right carotid artery and right subclavian arteries. We report a case of an adult female patient with RAMI discovered as an incidental finding during radiological investigations for suspected pulmonary embolism in emergency department. No other congenital malformations were reported. It is important to recognize congenital variants of the aortic arch, as they can have relevant implications for patients’ prognosis and management. Therefore, being aware of these conditions is key to avoid any mistakes or surgical and endovascular complications.
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Key Words
- ALSA, Aberrant Left Subclavian Artery
- CHD, Congenital Heart Disease
- CT, Computed Tomography
- Congenital vascular anomalies
- Incidental finding
- LCCA, Left Common Carotid artery
- LIA, Left Innominate Artery
- LSA, Left Subclavian Artery
- MR, Magnetic Resonance
- RAA, Right Aortic Arch
- RAMI
- RAMI, Right aortic arch with mirror image branching
- RCCA, Right Common Carotid artery
- RSA, Right Subclavian Artery
- Right aortic arch
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Affiliation(s)
- Daniele Morosetti
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Carla Di Stefano
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Mariateresa Mondillo
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Maria Claudia Pensabene
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Laura De Corato
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Mirko Bizzaglia
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Arezia Di Martino
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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Syperek A, Angermaier A, Kromrey ML, Hosten N, Kirsch M. The so-called "bovine aortic arch": a possible biomarker for embolic strokes? Neuroradiology 2019; 61:1165-1172. [PMID: 31372674 DOI: 10.1007/s00234-019-02264-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/12/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the prevalence of the so-called bovine aortic arch variation (common origin of the brachiocephalic trunk and the left common carotid artery) in embolic stroke patients, compared with a control group. METHODS Aortic arch branching patterns were retrospectively evaluated in 474 individuals with (n = 152) and without (n = 322) acute embolic stroke of the anterior circulation. Contrast-enhanced CT scans of the chest and neck (arterial contrast phase, 1-2-mm slice thickness) were used to evaluate aortic arch anatomy. The stroke cohort included 152 patients who were treated for embolic strokes of the anterior circulation between 2008 and 2018. A total of 322 randomly selected patients who had received thoracic CT angiographies within the same time frame were included as a control group. RESULTS With a prevalence of 25.7%, the bovine aortic arch variant was significantly more common among patients suffering from embolic strokes, compared with 17.1% of control patients (p = 0.039, OR = 1.67, 95%CI = 1.05-1.97). Stroke patients were more likely to show the bovine arch subtype B (left common carotid artery originating from the brachiocephalic trunk instead of the aortic arch) (10.5% vs. 5.0%, p = 0.039, OR = 2.25, 95%CI = 1.09-4.63), while subtype A (V-shaped common aortic origin of the brachiocephalic trunk and the left carotid) was similarly common in both groups. There was no significant difference regarding the frequency of other commonly observed variant branching patterns of the aortic arch. CONCLUSION The bovine aortic arch, particularly the bovine arch subtype B, was significantly more common among embolic stroke patients. This might be due to altered hemodynamic properties within the bovine arch.
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Affiliation(s)
- Annika Syperek
- Institute for Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Anselm Angermaier
- Department of Neurology, Greifswald University Hospital, Greifswald, Germany
| | - Marie-Luise Kromrey
- Institute for Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Norbert Hosten
- Institute for Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Michael Kirsch
- Institute for Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
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Wu WW, Liang P, O'Donnell TFX, Swerdlow NJ, Li C, Wyers MC, Schermerhorn ML. Anatomic eligibility for transcarotid artery revascularization and transfemoral carotid artery stenting. J Vasc Surg 2019; 69:1452-1460. [PMID: 30853384 PMCID: PMC6478535 DOI: 10.1016/j.jvs.2018.11.051] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/13/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Transcarotid artery revascularization (TCAR) has emerged as an alternative to transfemoral carotid artery stenting (tfCAS). We investigated the proportion of carotid arteries undergoing revascularization procedures that would be eligible for TCAR based on anatomic criteria and how many arteries at high anatomic risk for tfCAS would be amenable to TCAR. METHODS We performed a retrospective review of consecutive patients who underwent carotid endarterectomy or carotid stenting between 2012 and 2015. Patients were excluded if computed tomography angiography of the neck was not performed within 6 months of the procedure. We assessed TCAR eligibility on the basis of the instructions for use of the ENROUTE Transcarotid Neuroprotection System (Silk Road Medical, Sunnyvale, Calif) and high anatomic risk for tfCAS on the basis of anatomic factors known to make carotid cannulation more difficult or hazardous. RESULTS Of the 118 patients and 236 carotid arteries identified, 12 carotid arteries were excluded for presence of an occluded internal carotid artery (ICA). Of the remaining 224 carotid arteries, 72% were eligible for TCAR on the basis of the instructions for use criteria; 100% had 4- to 9-mm ICA diameters, 100% had ≥6-mm common carotid artery (CCA) diameter, 75% had ≥5-cm clavicle to carotid bifurcation distance, and 96% lacked significant CCA puncture site plaque. In addition, 7% of carotid arteries had bifurcation anatomy unfavorable for stenting; thus, of the entire cohort of arteries examined, 68% were eligible for TCAR. Hyperlipidemia (odds ratio [OR], 6.7; 95% confidence interval [CI], 1.7-26; P < .01), chronic obstructive pulmonary disease (OR, 3.5; 95% CI, 1.5-8.3; P < .01), and older age (OR, 1.1; 95% CI, 1.0-1.1; P < .01) were independently associated with TCAR ineligibility, whereas white race (OR, 0.2; 95% CI, 0.0-1.0; P = .048) and beta-blocker use (OR, 0.3; 95% CI, 0.1-0.7; P < .01) were independently associated with TCAR eligibility. In addition, 24% of carotid arteries were considered to be at high risk for tfCAS for the presence of a type III aortic arch (7.6%), severe aortic calcification (3.3%), tandem CCA lesions (7.1%), moderate to severe stenosis at the carotid ostium (8.9%), and tortuous distal ICA precluding embolic filter placement (4.5%). Active smoking (OR, 4.4; 95% CI, 1.9-10; P < .01), hyperlipidemia (OR, 4.0; 95% CI, 1.2-14; P = .03), and older age (OR, 1.1; 95% CI, 1.0-1.1; P = .02) were independently associated with tfCAS ineligibility, whereas preoperative aspirin (OR, 0.1; 95% CI, 0.0-0.4; P < .001) or clopidogrel (OR, 0.3; 95% CI, 0.1-0.8; P = .01) use was associated with tfCAS eligibility. Of the arteries that were considered to be at high risk for tfCAS, 69% were eligible for TCAR. CONCLUSIONS The majority of carotid arteries in individuals selected for revascularization meet TCAR eligibility, making TCAR a viable treatment option for many patients.
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Affiliation(s)
- Winona W Wu
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Patric Liang
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Thomas F X O'Donnell
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Nicholas J Swerdlow
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Chun Li
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Mark C Wyers
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
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Vascular Anatomy and Not Age is Responsible for Increased Risk of Complications in Symptomatic Elderly Patients Undergoing Carotid Artery Stenting. World Neurosurg 2019; 128:e513-e521. [PMID: 31048049 DOI: 10.1016/j.wneu.2019.04.187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Various studies have suggested that age ≥80 years is associated with a higher rate of complications after carotid artery stenting (CAS). The Buffalo Risk Assessment Scale (BRASS) predicts complications in symptomatic patients undergoing CAS. Application of the BRASS has shown the ability to improve patient selection. We used the BRASS system to evaluate whether the higher rate of complications associated with CAS in the elderly is related to vascular anatomy. METHODS A retrospective review of CAS was performed at our institution over 7 years. Demographic information, anatomic characteristics, BRASS categorization, and outcome measures were compared between elderly (≥80 years) and younger patients (<80 years). RESULTS The study included 447 patients: 335 patients (75%) <80 years and 112 patients (25%) ≥80 years. There were significantly more elderly patients in the high-risk BRASS category (P < 0.01), and more young patients in the low-risk BRASS category (P = 0.04). The complication rates in the 2 groups were similar. Older patients were more likely to harbor complex vascular anatomy: they had significantly higher rates of types II and III aortic arches (P = 0.01 and P < 0.01, respectively), higher percentage of tortuous carotid vessels (P < 0.01), and higher rates of hostile anatomy for deployment of distal embolic protection devices (P = 0.02). CONCLUSIONS Complex vascular anatomy, rather than age, is the key factor behind the higher CAS-associated complication rate in the elderly. Complications can be avoided through proper patient selection and stratifying patients based on anatomic characteristics, which can be achieved through the BRASS scoring system.
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Shen S, Jiang X, Dong H, Peng M, Wang Z, Che W, Zou Y, Yang Y. Effect of aortic arch type on technical indicators in patients undergoing carotid artery stenting. J Int Med Res 2018; 47:682-688. [PMID: 30378455 PMCID: PMC6381475 DOI: 10.1177/0300060518807604] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study was performed to explore the effect of the aortic arch type on technical indicators in patients undergoing carotid artery stenting (CAS). Methods The data of 224 consecutive patients who underwent unilateral CAS from January 2011 to December 2012 were retrospectively analyzed. The requirement for placement of the guiding catheter into the common carotid artery with assistance of an angiographic catheter, fluoroscopy time, contrast agent dose, and adverse events were recorded. Results The fluoroscopy time was significantly longer and the contrast agent dose was significantly higher in patients with Type III than Type I and II arches. Significantly more patients with Type III than Type I and II arches required placement of the guiding catheter with assistance of an angiographic catheter (46.2% vs. 15.0%, respectively). The procedural success rate was significantly lower in patients with Type III than Type I and II arches (96.2% vs. 100.0%, respectively). The incidence of death, myocardial infarction, and all types of stroke was significantly higher in patients with Type III than Type I and II arches (7.7% vs. 1.7%, respectively). Conclusions The aortic arch type is an important influential factor in CAS. Type III arches are associated with more difficulties and complications.
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Affiliation(s)
- Songhe Shen
- 1 Department of Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Xiongjing Jiang
- 2 Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Dong
- 2 Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Peng
- 3 Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhixue Wang
- 1 Department of Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Wuqiang Che
- 2 Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yubao Zou
- 2 Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- 2 Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Affiliation(s)
- Jason Han
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Hao Xiang
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Lloyd J Ridley
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Medical Imaging, University of Sydney, Sydney, New South Wales, Australia
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Sugrue G, O'Reilly MK, Byrne D, Crockett MT, Murphy S, Kavanagh EC. CT cervico-cerebral angiography in acute stroke. Can we justify aortic arch imaging? Ir J Med Sci 2018; 188:661-666. [PMID: 30143966 DOI: 10.1007/s11845-018-1888-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 08/14/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Computed tomography cervico-cerebral angiography (CTCCA) plays a pivotal role in the evaluation of acute stroke. Currently no evidence justifies the inclusion of the upper chest in the CTCCA field of view. The aim of this study was to assess the prevalence and clinical significance of vascular findings identified on CTCCA in the head, neck, and upper chest regions in patients presenting with acute stroke symptoms. METHODS A retrospective review of radiology images and reports of 900 consecutive patients (425 men, 475 women; mean age 63.2 years, age range 19-99 years) with a suspected acute stroke who underwent CTCCA in the emergency department between January 2011 and July 2016. Clinically significant vascular CTCCA findings were recorded for each patient within the head, neck, and upper chest regions, respectively. RESULTS Of the 900 patients, clinically significant vascular CTCCA findings were identified in 404/900 (44.8%) patients. 218/900 (24.2%) were located within the head region; 174/900 (19.3%) within the neck; and 12/900 (2.4%) in the upper chest. Of the 12 vascular findings located within the upper chest, 3/900 (0.33%) were related to a clinically significant posterior circulation infarct. CONCLUSIONS Routine inclusion of the upper chest on CTCCA is currently difficult to justify in the evaluation of a suspected acute anterior circulation stroke, contributing significantly to total radiation dose without demonstrating significant extra-cranial vascular findings. Prospective studies adopting narrower fields of view excluding the upper chest are necessary.
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Affiliation(s)
- Gavin Sugrue
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland.
| | - Michael K O'Reilly
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Danielle Byrne
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Matthew T Crockett
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Sean Murphy
- Department of Stroke Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Eoin C Kavanagh
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
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Ito H, Uchida M, Sase T, Kushiro Y, Wakui D, Onodera H, Takasuna H, Morishima H, Oshio K, Tanaka Y. Risk Factors of Contralateral Microembolic Infarctions Related to Carotid Artery Stenting. Neurol Med Chir (Tokyo) 2018; 58:311-319. [PMID: 29887547 PMCID: PMC6048354 DOI: 10.2176/nmc.oa.2018-0023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study sought to analyze the incidence of contralateral microembolic infarctions (MIs) on diffusion-weighted imaging (DWI) following protected carotid artery stenting (CAS) and compared the difference of risk factors between ipsilateral and contralateral lesions. From April 2010 to March 2017, 147 CASs in 140 patients were performed. All the patients underwent DWI within 1 week before and 24 hrs after the procedures. CAS was successfully completed in 145 (98.6%) of the 147 procedures. Forty-nine (33.8%) patients with new MIs revealed on postprocedural DWI were enrolled. They were divided into ipsilateral and contralateral groups based on the side of the CAS and MIs. The ipsilateral group indicates patients with MIs exclusively on the side of CAS. The contralateral group includes patients with MIs on the opposite side of the CAS or both sides. Patients with MIs at vertebrobasilar territory were excluded. Patient characteristics, morphology of the carotid artery and aortic arch, and procedural data were retrospectively assessed and compared between the two groups. Twenty-two (15.2%) and 14 (9.7%) patients were assigned to the ipsilateral and contralateral groups, respectively. Advanced age, left-sided stenosis, severe aortic arch calcification (AAC) on chest X-ray and contralateral carotid occlusion significantly increased the occurrence of contralateral MIs. On multivariable logistic regression analysis, severe AAC was statistically more frequent in the contralateral group. In the present study, the incidences of contralateral MIs after CAS is relatively not low. Advanced aortic atherosclerosis is statistically predictive for contralateral MIs. AAC on chest X-ray is a useful finding for estimating aortic atherosclerosis in candidates for CAS.
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Affiliation(s)
- Hidemichi Ito
- Department of Neurosurgery, St. Marianna University School of Medicine
| | - Masashi Uchida
- Department of Neurosurgery, St. Marianna University School of Medicine
| | - Taigen Sase
- Department of Neurosurgery, St. Marianna University School of Medicine
| | - Yuichiro Kushiro
- Department of Neurosurgery, St. Marianna University School of Medicine
| | - Daisuke Wakui
- Department of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital
| | - Hidetaka Onodera
- Department of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital
| | - Hiroshi Takasuna
- Department of Neurosurgery, St. Marianna University School of Medicine
| | | | - Kotaro Oshio
- Department of Neurosurgery, St. Marianna University School of Medicine
| | - Yuichiro Tanaka
- Department of Neurosurgery, St. Marianna University School of Medicine
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Tayal R, Khakwani MZ, Lesar B, Sinclair M, Emporelli A, Spektor V, Cohen M, Wasty N. Takeoff orientation of the major aortic arch branches irrespective of arch type: Ramifications for brachiocephalic interventions including carotid stenting. SAGE Open Med 2018; 6:2050312118776717. [PMID: 29780588 PMCID: PMC5952282 DOI: 10.1177/2050312118776717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/18/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Our previous work demonstrating great ease and predictability of cannulation of the major aortic arch branches with an upwardly pointing 3DR catheter, irrespective of aortic arch type, led us to hypothesize that centering or “cresting” of these vessels must occur along the superior most aspect of the aortic arch in a curvilinear fashion. Methods: We retrospectively analyzed 111 computed tomographic scans of the chest and thoracic aorta with intravenous contrast performed at our hospital between April 2011 and May 2012 utilizing TeraRecon image reconstruction software. Four studies were excluded due to poor image quality and/or surgical changes to native aortic architecture. Results: Of the 107 studies included, 104 (97.2%) demonstrated centering of the major aortic arch branches on a curvilinear line “cresting” the superior most aspect of the aortic arch irrespective of arch type. Of the three studies that did not demonstrate this “cresting,” two were found to have aberrant right subclavian arteries associated with a type I aortic arch, and one had an aberrant right common carotid associated with a type II aortic arch. Conclusion: Operators engaging major aortic arch branches need to be mindful of the fact that these vessels are indeed centered on a line “cresting” along the superior most aspect of the aortic arch, and any algorithm that, by taking this information into account, reduces catheter manipulation in the aortic arch could potentially result in a reduction in distal atheroembolic events.
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Affiliation(s)
- Rajiv Tayal
- Divisions of Cardiology and Radiology, Cardiac Catheterization Lab, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - M Zain Khakwani
- Divisions of Cardiology and Radiology, Cardiac Catheterization Lab, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Benjamin Lesar
- Divisions of Cardiology and Radiology, Cardiac Catheterization Lab, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Michael Sinclair
- Divisions of Cardiology and Radiology, Cardiac Catheterization Lab, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Afroditi Emporelli
- Divisions of Cardiology and Radiology, Cardiac Catheterization Lab, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Vadim Spektor
- Divisions of Cardiology and Radiology, Cardiac Catheterization Lab, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Marc Cohen
- Divisions of Cardiology and Radiology, Cardiac Catheterization Lab, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Najam Wasty
- Divisions of Cardiology and Radiology, Cardiac Catheterization Lab, Newark Beth Israel Medical Center, Newark, NJ, USA
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Mylonas SN, Barkans A, Ante M, Wippermann J, Böckler D, Brunkwall JS. Prevalence of Bovine Aortic Arch Variant in Patients with Aortic Dissection and its Implications in the Outcome of Patients with Acute Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2018; 55:385-391. [PMID: 29338980 DOI: 10.1016/j.ejvs.2017.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 12/01/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE/BACKGROUND To investigate the prevalence of bovine arch (BA) among patients with type A and B aortic dissection, and to provide insight into the implication of this variation on the outcome of patients with acute or subacute type B aortic dissection (a/sTBAD). METHODS This retrospective cohort analysis includes patients with a/sTBAD admitted between January 2006 and December 2016. Computed tomographic angiograms (CTAs) of patients referred because of type A aortic dissection were also re-evaluated with regard to the presence of BA. As a control group, 110 oncological patients who had undergone a chest CTA for disease staging during the study period were enrolled. A total of 154 patients with a/sTBAD and 168 with type A aortic dissection were identified during the study period. RESULTS An overall prevalence of 17.6% for BA variants was revealed. The comparison between patients with aortic dissection and the control group showed no statistically significant difference in BA prevalence (17.7% vs. 17.3%; p = 1.0). No statistically significant difference in BA prevalence was observed when comparing patients with type A aortic dissection with those with type B aortic dissection (16.6% vs. 18.8%; p = .66). During a median follow-up period of 27.8 months, 30 patients died. The mortality rate among patients presenting a BA variant was 34.5%, whereas among patients without, it was 16.0% (p = .04). Multivariate analysis revealed the presence of a BA as an independent predictor of mortality (adjusted odds ratio 3.4, 95% confidence interval 1.2-9.8). CONCLUSION The BA should be considered as a predictor of the outcome for patients with type B aortic dissection.
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Affiliation(s)
- Spyridon N Mylonas
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany.
| | - Arthurs Barkans
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
| | - Marius Ante
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jens Wippermann
- Department of Cardiac and Thoracic Surgery, University of Cologne, Cologne, Germany
| | - Dietmar Böckler
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jan Sigge Brunkwall
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
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İnanç Y, İnanç Y, Ay H. The effect of demographic features on aortic arch anatomy and its role in the etiology of cerebrovascular disease. Neuropsychiatr Dis Treat 2018; 14:29-35. [PMID: 29302189 PMCID: PMC5741983 DOI: 10.2147/ndt.s152194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to retrospectively evaluate the distribution of aortic arches, the relationship with demographic characteristics, and the results of carotid and vertebral artery stenting procedures in patients diagnosed with cerebrovascular disease through the intra-arterial digital subtraction angiography (DSA) technique. METHODS A retrospective examination was performed on 288 patients diagnosed with cerebrovascular disease, who underwent DSA in the Department of Neurology of Gaziantep University Medical Faculty and Kahramanmaraş¸ Sütçü Imam University Medical Faculty. The patients were examined in respect of demographic features and aortic arch anatomic structure characteristics. All demographic characteristics, DSA, carotid, and vertebral artery stent results were recorded. RESULTS The patients comprised 60.1% males and 39.9% females with a mean age of 58.25 years. Type 2 aortic arch was found in 175 (60.7%) patients, Type 2 aortic arch in 99 (34.3%) patients, and Type 3 aortic arch in 14 (4.8%) patients. The right carotid artery stenosis rate was found to be higher in patients with Type 2 aortic arch (P=0.013). When the patients were evaluated according to the presence of a bovine arch, there was no significant difference in terms of age, carotid, and vertebral artery lesions (P>0.05). CONCLUSION The aortic arch and its branching properties were not found to have a direct effect on increased risk of cerebrovascular disease or stenting rates. This study can be considered to raise awareness for new studies to demonstrate the effect of aortic arch anatomic differences on cerebrovascular diseases.
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Affiliation(s)
- Yılmaz İnanç
- Department of Neurology, Faculty of Medicine, Kahramanmaraş Sutcu Imam University, Kahramanmaraş
| | - Yusuf İnanç
- Department of Neurology, Faculty of Medicine, Gaziantep University, Gaziantep
| | - Halil Ay
- Department of Neurology, Faculty of Medicine, Harran University, Harran, Turkey
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O'Malley AM, El Kininy WH, Debebe H, Burukan AB, Davy SW. A cadaveric study of aortic arch variation in an Irish population. Ir J Med Sci 2017; 187:853-858. [PMID: 29288397 DOI: 10.1007/s11845-017-1729-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 12/07/2017] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study is to investigate the incidence of variation in the branching pattern of aortic arch (AA) vessels in an Irish population. METHOD A cadaveric study of 24 subjects was conducted. The vessels of the AA were identified, their branching patterns were noted and photographed and the following measurements were recorded: the angle of the AA to the coronal plane, the distance from the midline to the brachiocephalic trunk (BCT); the left common carotid artery (LCC) ; the left subclavian artery (LSC), the distance between the BCT and the right subclavian artery (RSC); the RSC and the right vertebral artery (RVA), and between the LSC and left vertebral artery (LVA). RESULTS The 'normal' branching pattern (BCT, LCC, LSC) was observed in 79%. Thirteen percent had a two-branched AA (bovine variant), while the remainder had an aberrant left vertebral artery (LVA) originating from the AA. The mean distances from the midline to the BCT, LCC and LSC were 9.1, 10.8 and 21.4 mm, respectively. Mean distance from BCT to RSC was 34.09 mm. The mean distance from LSC to LVA was 39.79 mm, and the mean distance from RSC to RVA was 23.38 mm. The mean angle of the AA to the coronal plane was 59.02°. CONCLUSION This is the first study documenting the rates of variation of the AA in Ireland. Variation of AA branching is of radiological and surgical significance, particularly in the diagnosis and treatment of thoracic and head and neck diseases. Awareness of these variations is particularly relevant for interventionalists who access these vessels during endovascular surgery.
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Affiliation(s)
| | | | - Helina Debebe
- Anatomy Department, Trinity College, Dublin, Dublin, Ireland
| | | | - Shane W Davy
- Anatomy Department, Trinity College, Dublin, Dublin, Ireland.
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Popieluszko P, Henry BM, Sanna B, Hsieh WC, Saganiak K, Pękala PA, Walocha JA, Tomaszewski KA. A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch. J Vasc Surg 2017; 68:298-306.e10. [PMID: 28865978 DOI: 10.1016/j.jvs.2017.06.097] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/16/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aortic arch (AA) is the main conduit of the left side of the heart, providing a blood supply to the head, neck, and upper limbs. As it travels through the thorax, the pattern in which it gives off the branches to supply these structures can vary. Variations of these branching patterns have been studied; however, a study providing a comprehensive incidence of these variations has not yet been conducted. The objective of this study was to perform a meta-analysis of all the studies that report prevalence data on AA variants and to provide incidence data on the most common variants. METHODS A systematic search of online databases including PubMed, Embase, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, and CNKI was performed for literature describing incidence of AA variations in adults. Studies including prevalence data on adult patients or cadavers were collected and their data analyzed. RESULTS A total of 51 articles were included (N = 23,882 arches). Seven of the most common variants were analyzed. The most common variants found included the classic branching pattern, defined as a brachiocephalic trunk, a left common carotid, and a left subclavian artery (80.9%); the bovine arch variant (13.6%); and the left vertebral artery variant (2.8%). Compared by geographic data, bovine arch variants were noted to have a prevalence as high as 26.8% in African populations. CONCLUSIONS Although patients who have an AA variant are often asymptomatic, they compose a significant portion of the population of patients and pose a greater risk of hemorrhage and ischemia during surgery in the thorax. Because of the possibility of encountering such variants, it is prudent for surgeons to consider potential variations in planning procedures, especially of an endovascular nature, in the thorax.
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Affiliation(s)
- Patrick Popieluszko
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
| | - Beatrice Sanna
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy
| | - Wan Chin Hsieh
- International Evidence-Based Anatomy Working Group, Krakow, Poland; First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karolina Saganiak
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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Clerici G, Giulietti E, Babucci G, Chaoui R. Bovine aortic arch: clinical significance and hemodynamic evaluation. J Matern Fetal Neonatal Med 2017; 31:2381-2387. [DOI: 10.1080/14767058.2017.1342807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Graziano Clerici
- Centre of Reproductive and Perinatal Medicine, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Eleonora Giulietti
- Department of Obstetrics/Gynecology, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Giulia Babucci
- Department of Obstetrics/Gynecology, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Rabih Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
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Huntress LA, Nassiri N, Shafritz R, Rahimi SA. Transcervical Carotid Stent Placement in the Setting of a Hostile Neck and a Type III Aortic Arch. Vasc Endovascular Surg 2017; 51:346-349. [DOI: 10.1177/1538574417710601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous radical neck dissection and neck irradiation pose considerable operative risks in patients requiring carotid endarterectomy for symptomatic carotid disease. Carotid stenting is an acceptable alternative for these patients but carries a higher risk of cerebrovascular accidents especially in patients with type III aortic arch anatomy. Herein, we present a technically challenging case of a patient with an irradiated neck and a history of radical neck dissection who presented with a symptomatic high-grade left internal carotid artery stenosis in the setting of a type III aortic arch. He was treated via a hybrid approach for carotid artery stenting.
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Affiliation(s)
| | - Naiem Nassiri
- Division of Vascular Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Randy Shafritz
- Division of Vascular Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Saum A. Rahimi
- Division of Vascular Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Synchronous Carotid Bifurcation Endarterectomy and Retrograde Kissing Stenting of the Innominate and Left Common Carotid Artery in a Patient with a Bovine Aortic Arch. Case Rep Surg 2017; 2017:4239829. [PMID: 28487806 PMCID: PMC5405376 DOI: 10.1155/2017/4239829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 04/02/2017] [Indexed: 11/18/2022] Open
Abstract
Management of the symptomatic multiple stenosis of supra-aortic vessels (MSSVs) in a “bovine” aortic arch (BAA) configuration is infrequently reported. The optimal treatment choice remains debatable. A successful hybrid treatment for a proximal critical stenosis of the innominate and left common carotid artery was performed in a high-risk patient with a tandem symptomatic lesion in the right carotid bifurcation and a concentric vulnerable plaque in the bovine trunk. This case supports the feasibility, safety, and efficacy of a combined carotid bifurcation endarterectomy and retrograde kissing stenting of common carotid arteries with cerebral protection after evaluation of radiological, anatomical, and clinical parameters.
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Symptomatic Carotid Artery Disease: Revascularization. Prog Cardiovasc Dis 2017; 59:601-611. [DOI: 10.1016/j.pcad.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 04/16/2017] [Indexed: 02/02/2023]
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