Impact of Aortic Arch Morphology on Periprocedural Neurologic Events during Carotid Artery Stenting

Nattawut Wongpraparut MD1, Sakaorat Kornbongkotmas MD1, Damras Tresukosol MD1, Viyada Sangsri BSc2, Rungtiwa Pongakasira BSc2

Affiliation : 1 Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Her Majesty’s Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Objective : To investigate the impact of aortic arch morphology on neurologic events and complications during and after carotid artery stenting [CAS].
Materials and Methods : This retrospective study enrolled 130 patients (144 procedures) with symptomatic or asymptomatic carotid stenosis that were treated at our center between January 2006 and December 2013.
Results : All 130 patients were at high risk for periprocedural neurologic events and death from carotid endarterectomy [CEA]. Baseline clinical characteristics, angiographic data, procedural characteristics, and periprocedural (30-day) neurologic events were assessed. The primary endpoint was the incidence of periprocedural neurologic events. Thirteen (9%) periprocedural neurologic events were observed, eight (5.5%) of which quali(cid:976)ied as major stroke. The periprocedural neurologic events rate was higher in the elderly and occurred in 2.7% of patients with type I arch, 8.1% of patients with type II arch, and 25% of patients with type III arch. Heavily calci(cid:976)ied lesion also increased the rate of periprocedural neurologic events. Multivariate analysis identi(cid:976)ied type III aortic arch (odds ratio [OR] 6.23, p = 0.006), presence of more than 50% common carotid stenosis (OR 4.33, p = 0.035), and heavily calci(cid:976)ied lesion (OR 4.15, p = 0.054) as risk factors for a periprocedural event.
Conclusion : Type III aortic arch morphology is signi(cid:976)icantly associated with periprocedural neurologic events during and after CAS.

Keywords : Carotid artery stent, Aortic arch type, Periprocedural neurologic event

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