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International Angiology 2020 Oct 21

DOI: 10.23736/S0392-9590.20.04494-6

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Aortic arch types and postoperative outcomes after carotid artery stenting in asymptomatic and symptomatic patients

Renato CASANA 1, 2 , Daniele BISSACCO 3, Chiara MALLOGGI 2, Valerio S. TOLVA 4, Andrea ODERO Jr 1, Maurizio DOMANIN 3, 5, Santi TRIMARCHI 3, 5, Vincenzo SILANI 6, 7, Gianfranco PARATI 8, 9

1 Department of Surgery, Istituto Auxologico Italiano, IRCCS, Milan, Italy; 2 Laboratory of Research in Vascular Surgery, Istituto Auxologico Italiano, IRCCS, Milan, Italy; 3 Vascular Surgery Unit, IRCCS Ospedale Maggiore Policlinico, Milan, Italy; 4 Department of Vascular and Endovascular Surgery, Policlinico di Monza, Monza, Italy; 5 Università degli Studi di Milano, Milan, Italy; 6 Department of Neurology-Stroke Unit and Laboratory of Neuroscience, Ospedale San Luca, Istituto Auxologico Italiano, IRCCS, Milan, Italy; 7 Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; 8 Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Istituto Auxologico Italiano, IRCCS, Milan, Italy; 9 Department of Medicine and Surgery, Università di Milano-Bicocca, Monza, Italy


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AIM: To investigate the influence of the aortic arch type on technical and clinical success of carotid artery stenting (CAS) procedure.
MATERIAL AND METHODS: Clinical and anatomical data of consecutive patients who underwent CAS from 2010 to 2018 were prospectively collected and retrospectively analyzed. Primary outcome was technical success, define as successful stent delivery and deployment and <30% residual carotid stenosis. Secondary outcomes were death, stroke, myocardial infarction (MI) and transient ischemic attack (TIA) rates at 30 days after CAS. Subgroups analysis with asymptomatic and symptomatic patients were also performed.
RESULTS: During the study period, 523 patients were enrolled and analyzed. Among these, 176 (33.6%) had Type I, 227 (43.4%) had Type II and 120 (23.0%) had Type III or bovine aortic arch (BAA) type. Technical success rate was achieved in 96.0% of cases. At 30 days, if compared with Type I or II, patient with Type III or BAA experienced a higher death rate (0 vs 0 vs 1.8%, respectively; p=.056) and combined postoperative stroke/TIA rate (3% vs 2.8% vs 9.9%, respectively; p=.012). No differences for same outcomes between asymptomatic and symptomatic patients were described, although the latter group experienced more postoperative MI. A multivariate analysis revealed Type III or BAA as an independent risk factor for postoperative stroke/TIA (HR 3.23, IC95% 1.40-7.45; p=.006).
CONCLUSIONS: In this cohort of patients, death and postoperative neurological complications rates were associated with Type III or BAA, irrespective of symptomatic patients’ status. Extremely attention is required during perioperative period in patients candidate to CAS and with challenging aortic arch anatomy.


KEY WORDS: Carotid artery disease; Carotid artery stenting; Stroke; Aortic arch

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