Bovine Arch and Stroke Laterality

Abstract

Background Left‐hemispheric strokes are more frequent and often have a worse outcome than their right‐hemispheric counterparts. This study aimed to evaluate whether cardioembolic stroke laterality is affected by anatomical characteristics of the aortic arch. We hypothesized that laterality varies between patients with bovine versus standard arch. Methods and Results We retrospectively identified 1598 acute cardioembolic strokes in patients with atrial fibrillation from our institutional stroke database (2009–2017). Inclusion criteria were acute anterior circulation ischemic infarct and availability of both arch and brain imaging (magnetic resonance imaging or computed tomography). Alternative causes of stroke and anomalous arch were excluded. Imaging was reviewed for stroke characterization and laterality and arch branching pattern. Bovine arch denotes a common origin of the brachiocephalic trunk and left common carotid artery. Strokes were classified as bilateral (left or right). Univariate analysis was performed using chi‐square tests. The final cohort comprised 615 patients, mean age 77 years ( SD 11.8 years) with 376 women (61%) and 33% white, 30% black, and the remainder mixed/Hispanic. Standard arch (n=424) stroke distribution was left 43.6% (185), right 45.1% (191), and bilateral 11.3% (48). Bovine arch (n=191) stroke distribution was left 51.3% (98), right 35.6% (68), and bilateral 13.1% (25). Bovine arches were associated with more left‐sided strokes compared with standard arches ( P =0.018). There was an association between black race and bovine arch ( P =0.0001). Conclusions Bovine aortic arch configuration is associated with left hemispheric laterality of cardioembolic stroke. This study enriches the understanding that arch anatomy influences stroke laterality and highlights the need for further research into the causative hemodynamic factors.

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

“…They observed a significantly higher prevalence of the bovine aortic arch among stroke patients (25.7%) than that among controls (17.1%) (odds ratio 1.67); stroke patients were significantly more likely to have the CILCA 2 (10.5%) than controls (5.0%) (odds ratio 2.25), while the CILCA 1 variant was similarly common in both groups, showing the higher clinical relevance of detecting the CILCA 2 variant. In addition, in a cohort of 615 stroke patients [43], left laterality of cardioembolic stroke has been shown to be significantly more frequent (51.3%) in patients with the bovine arch variant than in patients with standard arch (43.6%), demonstrating that the arch anatomy influences stroke laterality and fostering further research into the causative hemodynamic factors.…”

Stroke Lateralization in Large Hemisphere Infarctions: Characteristics, Stroke-Related Complications, and Outcomes

“…Several studies have reported the left-right propensity of cardioembolic infarcts, but no consensus has been reached so far (29)(30)(31)(32)(33)(34). Although the left hemisphere propensity of cardiogenic emboli has been reported (29,30), some researches supported the right-sided propensity of cardio-embolism, especially those associated with atrial fibrillation (31,32).…”

“…Although the left hemisphere propensity of cardiogenic emboli has been reported (29,30), some researches supported the right-sided propensity of cardio-embolism, especially those associated with atrial fibrillation (31,32). A recently published work indicated that bovine aortic arch was associated with left hemisphere laterality of cardioembolic stroke compared with standard arches (33). Another work suggested that there was a trend toward right-sided lesions in patients with standard arches, but no significant difference in cardio-embolic stroke laterality of patients with bovine arches was demonstrated (34).…”

“…Our results could be explained by the fact that the brachiocephalic artery is the first branch off the aortic arch, has the largest ostium, and heads upward and parallel to the direction of the ascending aorta. So large-sized cardiogenic emboli would therefore have a higher propensity to enter the brachiocephalic artery (which supplies the right common carotid and right subclavian) rather than the left common carotid artery, which arises second from the aortic arch and has an orientation perpendicular to it (33)(34)(35). Further study is warranted to determine whether there is a difference in the laterality of cardiogenic infarct depending on the size of embolic particles besides the aortic arch branching pattern.…”

Bilateral carotid artery occlusion associated with bovine arch

“…A sudden obstruction of the bilateral carotid artery is rare and has seldom been reported. 1,2 In this case, the bovine arch, namely the bilateral carotid artery beginning from a brachiocephalic artery, affected simultaneously, caused serious brain damage immediately. 2…”