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Clinical and procedural impact of aortic arch anatomic variants in carotid stenting procedures
Author(s) -
Burzotta Francesco,
Nerla Roberto,
Pirozzolo Giancarlo,
Aurigemma Cristina,
Niccoli Giampaolo,
Leone Antonio Maria,
Saffioti Silvia,
Crea Filippo,
Trani Carlo
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25947
Subject(s) - medicine , aortic arch , carotid stenting , carotid arteries , cardiology , aorta , radiology , surgery , carotid endarterectomy
Objectives To evaluate the impact of aortic arch variants in patients undergoing carotid artery stenting (CAS). Background CAS is increasingly carried out to treat the patients with internal carotid artery (ICA) stenosis. Aortic arch anatomy may influence its feasibility and affect clinical outcome. Methods Aortic arch digital subtraction angiography was systematically performed before CAS. Aortic arch elongation and bovine arch variants were recorded. Catheter manipulation time (CMT) was assessed for each patient. Adverse cardiovascular and cerebral events were assessed at 30 days. Results A total of 282 consecutive patients undergoing CAS under proximal balloon occlusion (57.8%) or distal filter (42.2%) neuroprotection were enrolled (age, 72 ± 7 years; 72.7% males). Type II and III elongation variants were detected in 23.4% and 10.6% of patients, respectively; in total, 20.5% of the patients had bovine configuration. CMT was significantly influenced by aortic elongation (56.1 ± 16.5 min in patients with type III aortic arch configuration compared to 38.2 ± 11.6 min in patients with type I or type II, P < 0.01) and (in left ICA) by bovine configuration (49.2 ± 11.4 min in bovine variants vs. 37.7 ± 11.5 min in patients with nonbovine anatomy, P < 0.001). CMT, but not aortic arch anatomy, resulted the only independent predictor of 30‐day adverse outcome (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.03–1.10, P < 0.01). Conclusions Adverse aortic arch anatomies are frequently encountered in CAS procedures and are associated to longer procedural times. A longer CMT increases the risk for adverse outcome. These data suggest that a careful procedure planning aimed at a reduction of CMT may be pivotal to improve the safety of CAS procedures. © 2015 Wiley Periodicals, Inc.