Bovine Arch and Stroke Laterality

Area of Science:

• Neurology
• Cardiology
• Anatomy

Background:

• Left-hemispheric strokes are more common and severe than right-hemispheric strokes.
• Aortic arch anatomy may influence cardioembolic stroke laterality.
• The bovine arch, a common variant, warrants investigation for its role in stroke patterns.

Purpose of the Study:

• To determine if aortic arch anatomy, specifically the bovine arch, affects the laterality of cardioembolic strokes.
• To investigate the association between bovine versus standard aortic arch and left- vs. right-hemispheric stroke distribution.

Main Methods:

• Retrospective analysis of 1598 acute cardioembolic strokes in patients with atrial fibrillation.
• Inclusion of patients with anterior circulation ischemic infarcts and available arch/brain imaging.
• Classification of aortic arches as standard or bovine, and strokes as left, right, or bilateral.

Main Results:

• The study included 615 patients (mean age 77 years, 61% women).
• Bovine arches (n=191) were associated with a higher proportion of left-sided strokes (51.3%) compared to standard arches (n=424) (43.6%) (P=0.018).
• A significant association was found between black race and bovine arch (P=0.0001).

Conclusions:

• Bovine aortic arch configuration is significantly associated with left hemispheric laterality of cardioembolic stroke.
• Aortic arch anatomy is a determinant of stroke laterality.
• Further research is needed to explore the hemodynamic factors underlying this association.