title: Clinical and procedural impact of aortic arch anatomic variants in carotid stenting procedures.
abstract: OBJECTIVE
  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.
authors.affiliation: Cardiovascular Sciences Department, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.affiliation: Cardiovascular Sciences Department, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Nerla
authors.affiliation: Cardiovascular Sciences Department, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Pirozzolo
authors.affiliation: Cardiovascular Sciences Department, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Aurigemma
authors.affiliation: Cardiovascular Sciences Department, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.affiliation: Cardiovascular Sciences Department, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
authors.affiliation: Cardiovascular Sciences Department, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Saffioti
authors.affiliation: Cardiovascular Sciences Department, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.affiliation: Cardiovascular Sciences Department, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D001013:Aorta, Thoracic / Q000033:anatomy & histology*; D021721:Balloon Occlusion; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D015897:Comorbidity; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
keywords: aortic arch anatomy; carotid artery stenting; periprocedural stroke