Feasibility of Using Neck Extension to Overcome a Difficult Aortic Arch and Gain Access to the Carotid Artery

The purpose of this study was to investigate neck movement and various conditions of the aortic arch that may hinder access to the carotid artery during neurointerventional procedures.

We reviewed 230 patients who underwent internal carotid artery angiography between February 2016 and October 2016. Use of a Davis catheter (DC) was first attempted and if not possible, movement (right, left, flexion, and extension) of the patient's head was tried before catheter exchange. We analyzed the success rate after neck motion in relation to various aortic arch factors.

Only extension of the patient's neck was effective. Of the 209 patients with right side angiography, 23 had failed access with a DC, but neck extension was effective in 3 patients (13%). Failure to insert a DC was significantly correlated with age, male sex, acute angle, arch elongation, aortic calcification, and carotid artery angulation on the right side, whereas access was not gained in 24 out of 208 patients who underwent left side angiography, and neck extension was successful in 7 patients (29.2%). Also, significant factors determining the catheter exchange were age, male sex, acute angle, arch elongation, and aortic calcification.In the DC access failure group, neck extension was significantly more effective for younger aged patients (P = 0.011).

Factors such as older age, acute arch angle, higher elongation type, arch calcification, and carotid artery angulation were verified as factors affecting access by a simple catheter; however, neck extension was shown to facilitate access in about 10%-30% of patents.