Atherosclerotic aortic lesions increase the risk of cerebral embolism during carotid stenting in patients with complex aortic arch anatomy

Abstract

BL are frequent after protected CAS and are correlated with AA characteristics, thus underlining the role of catheterization maneuvers in determining embolic events. TEE may be useful in patient's selection for CAS.

Repeated Brain Infarction Caused by Atherosclerosis of the Bovine Aortic Arch Successfully Treated With Arch Replacement

“…6) One of the difficulties is that both common carotid arteries have to be occluded for distal protection during the procedure. For those patients, surgical aortic arch replacement should be considered if intensified medical treatments are not effective for preventing further ischemic events.…”

Comparing Vessel Imaging

“…Neurointerventionists require not only information on the site of occlusion but also the anatomy of the arch of aorta and proximal extracranial neck vessels. CTA provides high-resolution images of the arch of aorta and neck vessels that provide information on great vessel thrombi, 61 aortic atherosclerosis, 62 anatomic variants (ie, bovine or type 1-3 arch 63 ), vessel angles, and tortuosity, 64 which each can affect the planning and duration of the endovascular procedure. 65,66 Access to the carotid circulation may require specialized access catheters to handle the curves and angles at bifurcation points.…”

Laboratory-Based Markers as Predictors of Brain Infarction During Carotid Stenting: a Prospective Study

“…Among vascular risk factors, only coronary artery disease has been identified as a significant predictor of microembolism after CAS 23) . Main documented risk factors associated with periprocedural risk of embolization are excessive manipulation with CAS devices 35) , plaque instability 36) , anatomic abnormalities (particularly tortuosity of the aortic arch and carotid artery) 30,32) , and atherosclerotic aortic plaques 30,37) . In (Cont Table 2 were selected on the basis of the literature and widely used laboratory tests.…”