Aortic arch anomalies, embryology and their relevance in neuro-interventional surgery and stroke: A review

Abstract

Background Congenital aortic arch anomalies are commonly encountered during neurointerventional procedures. While some anomalies are identified at an early age, many are incidentally discovered later in adulthood during endovascular evaluations or interventions. Proper understanding of the normal arch anatomy and its variants is pivotal to safely navigate normal aortic arch branches and to negotiate the catheter through anomalies during neurointerventional procedures. This is particularly relevant in the increasingly “transradial first” culture of neurointerventional surgery. Moreover, some of these anomalies have a peculiar predilection for complications including aneurysm formation, dissection, and rupture during the procedure. Therefore, an understanding of these anomalies, their underlying embryological basis and associations, and pattern of circulation will help endovascular neurosurgeons and interventional radiologists navigate with confidence and consider relevant pathologic associations that may inform risk of cerebrovascular disease. Methods Here, we present a brief review of the basic embryology of the common anomalies of the aortic arch along with their neurological significances and discuss, through illustrative cases, the association of aortic arch anomalies with cerebral vascular pathology. Conclusions Understanding the aortic arch anomalies and its embryological basis is essential to safely navigate the cerebral vascular system during neurointerventional surgeries.

A Fatal Case of Ruptured Aberrant Left Subclavian Artery into the Oesophagus

“…Failure in this complex process give rise to congenital anomalies as seen in this case. [4] Here the left subclavian, which was aberrant in nature has ruptured into the esophagus causing massive bleeding. Pallor organs, pools of internal blood, shock hemorrhages in the left ventricular myocardium supports the diagnosis of hemorrhagic shock.…”

A Combined Deep Learning System for Automatic Detection of “Bovine” Aortic Arch on Computed Tomography Scans

“…Conversely, the significantly different proportion of false-negative CILCA 1 (42%) and CILCA 2 (15%) highlights that when the CILCA variant is anatomically more different from the non-CILCA pattern (i.e., it is a CILCA 2), the automatic tool reaches an 85% sensitivity, while in the cases of CILCA 1 the tool is more prone to miss the variant (sensitivity 58%). This difference could be related to the fact that the CILCA variants are the results of an embryologic anatomical continuum of the origin of the left carotid artery that moves from distal to proximal portions of the aortic arch, becoming CILCA 1 in the case of common origin with the innominate artery [40,44]. So, the difference between a standard arch with a proximal origin from the arch, adjacent to the innominate artery, and a CILCA 1 variant with a very short common vessel may be very subtle and difficult to differentiate.…”

Right-sided aortic arch with complex anomalies presented with transient ischemic attack

“…[22] e likelihood of cerebral infarction will increase as a result, as cardiac abnormalities constitute at least 20% of the causes of ischemic strokes. [9,10] However, in this article, we report a case of RAA anomaly with an ALSA and Kommerell's diverticulum associated with aneurysmal dilation of the ascending aorta, left common carotid artery (CCA) stenosis of approximately 30-40%, and pancake kidney presented with a transient ischemic attack (TIA). is is the first case in the literature that discusses such associations, especially in a symptomatic patient with neurological rather than tracheaesophageal symptoms with the absence of the steal phenomenon.…”

“…[ 22 ] The likelihood of cerebral infarction will increase as a result, as cardiac abnormalities constitute at least 20% of the causes of ischemic strokes. [ 9 , 10 ]…”