title: Carotid artery stenting in difficult aortic arch anatomy with or without a new dedicated guiding catheter: preliminary experience.
abstract: OBJECTIVE
  To evaluate carotid artery stenting (CAS) procedures with or without a new dedicated guiding catheter in anatomically challenging aortic arches in our experience.
  
  
  METHODS
  We retrospectively reviewed 172 procedures of CAS performed from December 2006 to October 2011 in 159 consecutive patients (100 men, mean age 78 years): 15 patients had type III aortic arch, 13 had a bovine aortic arch, 6 had an acute angle at the origin of the left common carotid artery from the aortic arch, 2 had type III aortic arch with bovine aortic arch, and 1 had a bicarotid trunk with an aberrant right subclavian artery. In this group of difficult anatomy (37 cases), CAS was performed with (13 cases) or without (24 cases) a new dedicated guiding catheter.
  
  
  RESULTS
  Mean time of fluoroscopy (16 min vs. 18 min, P < 0.01), mean total procedural time (68 min vs. 83 min, P < 0.001), technical failure (0/13 vs. 3/24 cases, P = 0.01), clinical failure (0/13 vs. 4/21 cases, P = 0.02) and local complications (0/13 vs. 2/24 cases, P < 0.0001) were significantly lesser in the dedicated guiding catheter group.
  
  
  CONCLUSIONS
  The new dedicated guiding catheter may be more effective and less risky for CAS in anatomically challenging aortic arches.
  
  
  CONCLUSIONS
  • Complex anatomy of the aortic arch is not rare • Endovascular carotid artery stenting (CAS) is more difficult when the anatomy is complex • A new dedicated guiding catheter may help CAS when the arch anatomy is complex • The new dedicated guiding catheter may be less risky in complex arches.
authors.affiliation: Department of Radiology, St.Bassiano Hospital, ULSS n.3, 40 Via dei Lotti, 36061, Bassano del Grappa (Vicenza), Italy. giuliobarbiero@katamail.com
authors.forename: Giulio
authors.initials: G
authors.lastname: Barbiero
authors.forename: Diego
authors.initials: D
authors.lastname: Cognolato
authors.forename: Andrea
authors.initials: A
authors.lastname: Casarin
authors.forename: Rudi
authors.initials: R
authors.lastname: Stramanà
authors.forename: Elisa
authors.initials: E
authors.lastname: Galzignan
authors.forename: Alessandro
authors.initials: A
authors.lastname: Guarise
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D002339:Carotid Arteries / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002406:Catheterization, Peripheral / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019919:Prosthesis Implantation / Q000379:methods; D011859:Radiography; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome