Author + information
- Rajiv Tayal,
- Benjamin LeSar,
- Isheeka Edwards,
- Afroditi Emporelli,
- Vadim Spektor,
- Marc Cohen and
- Najam Wasty
Distal embolic events (DEEs) are frequent during carotid artery stenting (CAS) and often occur in non–targeted cerebral vessels (NTCs). Type II and III aortic arches (AA) are associated with worse outcomes in carotid interventions in having lower rates of technical success and higher incidences of neurological events. We have previously demonstrated the safety and efficacy of 3DR catheter cannulation of the brachiocephalic arteries (BCAs) using a sequential withdrawal technique due to the anatomical “cresting” of the BCAs in originating from the superior most part of the AA. However it remains unclear as to whether arch type affects this anatomical relationship.
We retrospectively reviewed 111 randomly selected chest computed tomography scans with intravenous contrast using Terrarecon software. The superior most portion of the aorta was defined by manually adjusting the Curve Planar Reformation (CPR) function and referencing it in all views. This line was then followed in a saggital bird's eye view and marked if it intersected the origin of the BCA at the superior most portion of the AA.
Mean age was 58.2+/–15.9 years, 58.9% were hypertensive, 11.2% had CAD and 20.5% had diabetes. 4 studies were excluded due to post surgical changes, poor contrast bolus or artifact. 64/107 (59.8%) of patients were found to have a type 1 AA, 14/104 (13.1%) type 2 AA, 10/107 (9.3%) type 3 AA, and 19/107 (17.8%) a bovine AA. 104/107 (97.2%) studies demonstrated “crested” BCAs arising from the superior most portion of the aorta. Of the 3 studies that were not, 2 had aberrant right subclavian arteries associated with a type 1 AA, and 1 had an aberrant right common carotid associated with a type 2 AA.
The BCAs are “crested” along a line traversing the superior most aspect of the AA irrespective of arch type. Accordingly an atraumatic way to canulate the BCAs is to pull the upwardly pointing 3DR catheter from the most proximal BCA ostium to the next without rotation. Incorporating this methodology in CAS algorithms might improve procedural success rates and enhance safety of the procedure especially as it relates to DEEs in the NTC by eliminating the need to rotate or push catheters in the AA.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Endovascular Intervention
Abstract Category: 41. TCT@ACC–i2: Carotid, Neurovascular, and Endovascular Intervention
Presentation Number: 2109–225
- 2013 American College of Cardiology Foundation