Vascular Anatomy Predicts the Risk of Cerebral Ischemia in Patients Randomized to Carotid Stenting Versus Endarterectomy

Müller, Mandy D.; Ahlhelm, F.; Hessling, Alexander von; Doig, David; Nederkoorn, Paul J.; Macdonald, Sumaira; Lyrer, Philippe; Lugt, Aad van der; Hendrikse, Jeroen; Stippich, Christoph; Worp, H. Bart van der; Richards, Toby; Brown, Martin M.; Engelter, Stefan T.; Bonati, Leo H.

doi:10.1161/strokeaha.116.014612

Cited by 55 publications

(20 citation statements)

References 26 publications

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“…Although the CCIA has never been specifically shown to have an influence on procedural times in mechanical thrombectomy, unfavorable arch types (type II or III) have been associated with more ischemic events and longer procedural times in patients undergoing carotid stent placement. [15][16][17][18] However, most of these studies found subjective associations primarily with arch type or, in 1 study, a composite "B.A.D. score" based on bovine variation, arotic arch type, and ICA dolichoarteriopathy.…”

Section: Discussionmentioning

confidence: 90%

Impact of Aortic Arch Anatomy on Technical Performance and Clinical Outcomes in Patients with Acute Ischemic Stroke

Knox¹,

Alexander

McCoy³

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Arterial access is a technical consideration of mechanical thrombectomy that may affect procedural time, but few studies exist detailing the relationship of anatomy to procedural times and patient outcomes. We sought to investigate the respective impact of aortic arch and carotid artery anatomy on endovascular procedural times in patients with large-vessel occlusion. MATERIALS AND METHODS: We retrospectively reviewed imaging and medical records of 207 patients from 2 academic institutions who underwent mechanical thrombectomy for anterior circulation large-vessel occlusion from January 2015 to July 2018. Preintervention CTAs were assessed to measure features of the aortic arch and ipsilateral great vessel anatomy. These included the cranial-to-caudal distance from the origin of the innominate artery to the top of the aortic arch and the takeoff angle of the respective great vessel from the arch. mRS scores were calculated from rehabilitation and other outpatient documentation. We performed bootstrap, stepwise regressions to model groin puncture to reperfusion time and binary mRS outcomes (good outcome, mRS # 2). RESULTS: From our linear regression for groin puncture to reperfusion time, we found a significant association of the great vessel takeoff angle (P 4 .002) and caudal distance from the origin of the innominate artery to the top of the aortic arch (P 4 .05). Regression analysis for the binary mRS revealed a significant association with groin puncture to reperfusion time (P , .001). CONCLUSIONS: These results demonstrate that patients with larger takeoff angles and extreme aortic arches have an association with longer procedural times as approached from transfemoral access routes. ABBREVIATIONS: CCA 4 common carotid artery; CCIA 4 the cranial-to-caudal distance from the origin of the innominate artery to the top of the aortic arch; GPRT 4 groin puncture to reperfusion time; HTN 4 hypertension; LVO 4 large-vessel occlusion I schemic stroke is the fifth leading cause of death and the leading cause of long-term disability in the United States. 1 Recent studies have established mechanical thrombectomy as the criterion standard of care for large-vessel occlusion over tPA alone. 2-5 These and other studies have demonstrated that reduced time between the onset of symptoms and reperfusion leads to better clinical outcomes. 6,7 That time interval comprises prehospital

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Section: Discussionmentioning

confidence: 90%

Impact of Aortic Arch Anatomy on Technical Performance and Clinical Outcomes in Patients with Acute Ischemic Stroke

Knox¹,

Alexander

McCoy³

et al. 2020

AJNR Am J Neuroradiol

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“…Current studies showed an association between aortic plaques and catheter maneuvers. 6 , 9 , 18 , 20 , 25 – 29) Bazan et al 25) reported high aortic arch calcium content, measured using special software with thoracic computed tomography, may be a marker of increased potential for MIs during arch manipulation. And Faggioli et al 20) suggested that thick atherosclerotic plaques at the aortic arch evaluated by transesophageal echocardiography could increase the risk of contralateral cerebral embolism during protected CAS.…”

Section: Discussionmentioning

confidence: 99%

“…These unfavorable aortic arch configurations affect the difficulty of catheter maneuvering, prolonged duration of catheter navigation, the greater number of catheter exchanges, repeated endothelium traumas, and contrast injections with higher risks of emboli and thrombi. Muller et al 6) reported the importance of aortic arch configuration as one of the risk factors for MIs. Muller et al’s 6) results showed postprocedural MIs were statistically more frequent in patients with the targeted carotid artery that originated below the level of the outer curvature of the aortic arch.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors of Contralateral Microembolic Infarctions Related to Carotid Artery Stenting

Ito

Uchida

Sase

et al. 2018

Neurol. Med. Chir.(Tokyo)

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This study sought to analyze the incidence of contralateral microembolic infarctions (MIs) on diffusion-weighted imaging (DWI) following protected carotid artery stenting (CAS) and compared the difference of risk factors between ipsilateral and contralateral lesions. From April 2010 to March 2017, 147 CASs in 140 patients were performed. All the patients underwent DWI within 1 week before and 24 hrs after the procedures. CAS was successfully completed in 145 (98.6%) of the 147 procedures. Forty-nine (33.8%) patients with new MIs revealed on postprocedural DWI were enrolled. They were divided into ipsilateral and contralateral groups based on the side of the CAS and MIs. The ipsilateral group indicates patients with MIs exclusively on the side of CAS. The contralateral group includes patients with MIs on the opposite side of the CAS or both sides. Patients with MIs at vertebrobasilar territory were excluded. Patient characteristics, morphology of the carotid artery and aortic arch, and procedural data were retrospectively assessed and compared between the two groups. Twenty-two (15.2%) and 14 (9.7%) patients were assigned to the ipsilateral and contralateral groups, respectively. Advanced age, left-sided stenosis, severe aortic arch calcification (AAC) on chest X-ray and contralateral carotid occlusion significantly increased the occurrence of contralateral MIs. On multivariable logistic regression analysis, severe AAC was statistically more frequent in the contralateral group. In the present study, the incidences of contralateral MIs after CAS is relatively not low. Advanced aortic atherosclerosis is statistically predictive for contralateral MIs. AAC on chest X-ray is a useful finding for estimating aortic atherosclerosis in candidates for CAS.

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“…Even Ben Ahmed et al [ 2 ] noted that patients were indicated for conventional open surgery when complex lesions of SAT-like multilocular or highly calcified lesions were seen in their practice. Mueller et al [ 6 ] performed a randomized controlled trial comparing carotid artery stenting (CAS) and carotid endoarterectomy (CEA) in 184 patients, with 51% of patients in the CAS group and 16% of patients in the CEA group showing new ischemic brain lesions. They concluded that complex configuration of the aortic arch and internal carotid artery tortuosity increase the risk of cerebral ischemia during CAS, but not during CEA, so vascular anatomy should be taken into account when performing EVT.…”

Section: Discussionmentioning

confidence: 99%

Total arch replacement as treatment for repeated cerebral infarctions due to unstable plaque simultaneously in the innominate artery and left subclavian artery: a case report

Nakanishi

Ise

Ishikawa

et al. 2018

Journal of Surgical Case Reports

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Vascular Anatomy Predicts the Risk of Cerebral Ischemia in Patients Randomized to Carotid Stenting Versus Endarterectomy

Abstract: URL: http://www.isrctn.com/ISRCTN25337470. Unique identifier: ISRCTN25337470.

Cited by 55 publications

References 26 publications

Impact of Aortic Arch Anatomy on Technical Performance and Clinical Outcomes in Patients with Acute Ischemic Stroke

Impact of Aortic Arch Anatomy on Technical Performance and Clinical Outcomes in Patients with Acute Ischemic Stroke

Risk Factors of Contralateral Microembolic Infarctions Related to Carotid Artery Stenting

Total arch replacement as treatment for repeated cerebral infarctions due to unstable plaque simultaneously in the innominate artery and left subclavian artery: a case report

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