Impact of aortic arch morphology on periprocedural neurologic events during carotid artery stenting

Abstract

© 2018, Medical Association of Thailand. All rights reserved. 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 qualified 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 calcified lesion also increased the rate of periprocedural neurologic events. Multivariate analysis identified 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 calcified lesion (OR 4.15, p = 0.054) as risk factors for a periprocedural event. Conclusion: Type III aortic arch morphology is significantly associated with periprocedural neurologic events during and after CAS.