The so-called “bovine aortic arch”: a possible biomarker for embolic strokes?

Syperek, Annika; Angermaier, Anselm; Kromrey, Marie‐Luise; Hosten, Norbert; Kirsch, Michael

doi:10.1007/s00234-019-02264-3

Cited by 18 publications

(11 citation statements)

References 39 publications

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“…While no association between variant aortic arch branching pattern and intracranial aneurysms was found by Salehi et al [41], a significant association between CILCA variant and stroke was found by Syperek et al [42], who defined the bovine aortic arch as a "biomarker for embolic stroke". The authors retrospectively evaluated aortic arch branching patterns on contrast-enhanced CT scans of the chest and neck of 474 individuals, 152 of them with and 322 without acute embolic stroke of the anterior cerebral circulation.…”

Section: Discussionmentioning

confidence: 95%

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

Secchi

Interlenghi²,

Alì

et al. 2022

Applied Sciences

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The “bovine” aortic arch is an anatomic variant consisting in a common origin of the innominate and left carotid artery (CILCA), associated with a greater risk of thoracic aortic diseases (aneurysms and dissections), stroke, and complications after endovascular procedures. CILCA can be detected by visual assessment of computed tomography (CT) chest scans, but it is rarely reported. We developed a deep learning (DL) segmentation-plus-classification system to automatically detect CILCA based on 302 CT studies acquired at 2 centers. One model (3D U-Net) was trained from scratch (supervised by manual segmentation), validated, and tested for the automatic segmentation of the aortic arch and supra-aortic vessels. Three DL architectures (ResNet50, DenseNet-201, and SqueezeNet), pre-trained over millions of common images, were trained, validated, and tested for the automatic classification of CILCA versus non-CILCA, supervised by radiologist’s classification. The 3D U-Net-plus-DenseNet-201 was found to be the best system (Dice index 0.912); its classification performance obtained from internal, independent testing on 126 patients gave a receiver operating characteristic area under the curve of 87.0%, sensitivity 66.7%, specificity 90.5%, positive predictive value 87.5%, negative predictive value 73.1%, positive likelihood ratio 7.0, and negative likelihood ratio 0.4. In conclusion, a combined DL system applied to chest CT scans was developed and proven to be an effective tool to detect individuals with “bovine” aortic arch with a low rate of false-positive findings.

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Section: Discussionmentioning

confidence: 95%

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

Secchi

Interlenghi²,

Alì

et al. 2022

Applied Sciences

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“…BAT2, however, was more prevalent in males (14.08% versus 9.51% in males vs females, respectively). With regard to studies in which the BA type was unspecified, Syperek et al was the only study to specify incidence with regard to sex [29]. Taking data from this single study into account, males had a greater incidence of unspecified type of BA vs females (18.6% vs 15.3%, males vs females, respectively).…”

Section: Bovine Aortic Archmentioning

confidence: 97%

“…Eighteen studies reported cases exhibiting the normal configuration of the branching pattern of the AA [5,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. A total of 7187 specimens were reported to have this normal configuration of branching (average percentage prevalence: Fig.…”

Section: Normal Branching Pattern Of the Aortic Archmentioning

confidence: 99%

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Anatomical variation in the branching pattern of the aortic arch: a literature review

Murray

Meguid

2022

Ir J Med Sci

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Background Many anatomical variations of the branching pattern of the aortic arch have been documented in the literature. These find their origin in alterations to the embryological development of the arch and have significant implications for surgical and radiological interventions. Methods Embase and Medline database searches were carried out in June 2021 and identified 1197 articles, of which 24 were considered eligible. Results Twenty-eight variations were found. The prevalence of the six main variations found is as follows: normal configuration (61.2–92.59%); bovine arch type 1 (4.95–31.2%); bovine arch type 2 (0.04–24%); origin of left vertebral artery (0.17–15.3%); aberrant right subclavian artery (0.08–3.33%); thyroid ima artery (0.08–2%). Concomitant variations present in conjunction with these variations are also documented, as were other variations which could not be classified into these six groups. Conclusions Anatomical variations in the branching pattern of the aortic arch are present in over one-third of individuals in some populations. These are important pre- and intra-operatively during thoracic, neck and thyroid surgery. A greater effort should be employed to construct an official classification to facilitate greater understanding among clinicians.

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“…The prevalence of a bovine anomaly is significantly greater in patients with ischemic stroke than control subjects (25.7% vs 17.1%, OR 1.67, P = .039). 15 Furthermore, Matakas et al 16 have found that cardioembolic strokes are more likely to occur on the left in the context of a bovine anomaly when compared to a standard aortic arch (OR 1.57, P < .05). Given that left hemispheric strokes have greater morbidity and mortality than right sided strokes, this is a significant morbidity associated with the bovine arch.…”

Section: Literature Reviewmentioning

confidence: 99%

Vascular Variations in the Central Neck and Their Implications on Tracheostomy: Literature Review and Case Report

McEwen

Hoffman

2022

FACE

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Tracheostomy is a commonly performed procedure in the setting of head and neck cancer surgery, and generally performed with minimal morbidity and mortality. Iatrogenic injury to the brachiocephalic artery is an extremely rare event that can occur during the undertaking of a tracheostomy. Aberrant vascular anatomy can predispose to this catastrophic complication. Although not frequently encountered in clinical practice, vascular anomalies of the aortic arch branches can occur in up to 20% of the population. This review of the literature discusses the common branching, positional, and numerical variations of the aortic—brachiocephalic arterial anatomy in the root and central neck, and the implications of these vascular variants on the undertaking of a routine tracheostomy. The authors outline a case of catastrophic hemorrhage during a routine trache xostomy in a 69-year-old patient with a bovine aortic arch anomaly. The intraoperative sequalae, emergency management, imaging findings, and future implications of such an occurrence are discussed. The paper provides a timely reminder to surgeons to raise awareness of the variability of the vascular anatomy in the neck and the operative implications of surgical undertakings in the root of the neck.

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The so-called “bovine aortic arch”: a possible biomarker for embolic strokes?

Cited by 18 publications

References 39 publications

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

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

Anatomical variation in the branching pattern of the aortic arch: a literature review

Vascular Variations in the Central Neck and Their Implications on Tracheostomy: Literature Review and Case Report

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