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Carotid artery stenting in difficult aortic arch anatomy with or without a new dedicated guiding catheter:
Giulio Barbiero1, Diego Cognolato, Andrea Casarin
1Department of Radiology, St.Bassiano Hospital, ULSS n.3, 40 Via dei Lotti, 36061, Bassano del Grappa (Vicenza), Italy. giuliobarbiero@katamail.com
Objectives:
To evaluate carotid artery stenting (CAS) procedures with or without a new dedicated guiding catheter in anatomically challenging aortic arches in our experience.
Methods:
We retrospectively reviewed 172 procedures of CAS performed from December 2006 to October 2011 in 159 consecutive patients (100 men, mean age 78 years): 15 patients had type III aortic arch, 13 had a bovine aortic arch, 6 had an acute angle at the origin of the left common carotid artery from the aortic arch, 2 had type III aortic arch with bovine aortic arch, and 1 had a bicarotid trunk with an aberrant right subclavian artery. In this group of difficult anatomy (37 cases), CAS was performed with (13 cases) or without (24 cases) a new dedicated guiding catheter.
Results:
Mean time of fluoroscopy (16 min vs. 18 min, P < 0.01), mean total procedural time (68 min vs. 83 min, P < 0.001), technical failure (0/13 vs. 3/24 cases, P = 0.01), clinical failure (0/13 vs. 4/21 cases, P = 0.02) and local complications (0/13 vs. 2/24 cases, P < 0.0001) were significantly lesser in the dedicated guiding catheter group.
Conclusions:
The new dedicated guiding catheter may be more effective and less risky for CAS in anatomically challenging aortic arches.
Key Points:
• Complex anatomy of the aortic arch is not rare • Endovascular carotid artery stenting (CAS) is more difficult when the anatomy is complex • A new dedicated guiding catheter may help CAS when the arch anatomy is complex • The new dedicated guiding catheter may be less risky in complex arches.