Aortic arch types and postoperative outcomes after carotid artery stenting in asymptomatic and symptomatic patients

Background: The aim of this study was to investigate the influence of the aortic arch type on technical and
clinical success of carotid artery stenting (CAS) procedure.
Methods: Clinical and anatomical data of consecutive patients who underwent CAS from 2010 to 2018
were prospectively collected and retrospectively analyzed. Primary outcome was technical success, define as
successful stent delivery and deployment and <30% residual carotid stenosis. Secondary outcomes were death,
stroke, myocardial infarction (MI) and transient ischemic attack (TIA) rates at 30 days after CAS. Subgroups
analysis with asymptomatic and symptomatic patients were also performed.
Results: During the study period, 523 patients were enrolled and analyzed. Among these, 176 (33.6%) had Type
I, 227 (43.4%) had Type II and 120 (23.0%) had Type III or bovine aortic arch (BAA) type. Technical success
rate was achieved in 96.0% of cases. At 30 days, if compared with Type I or II, patient with Type III or BAA
experienced a higher death rate (0 vs. 0 vs. 1.8%, respectively; P=0.056) and combined postoperative stroke/TIA
rate (3% vs. 2.8% vs. 9.9%, respectively; P=0.012). No differences for same outcomes between asymptomatic
and symptomatic patients were described, although the latter group experienced more postoperative MI. A
multivariate analysis revealed Type III or BAA as an independent risk factor for postoperative stroke/TIA (HR
3.23, IC95% 1.40-7.45; P=0.006).
Conclusions: In this cohort of patients, death and postoperative neurological complications rates were
associated with Type III or BAA, irrespective of symptomatic patients’ status. Extremely attention is required
during perioperative period in patients who were candidate to CAS and with challenging aortic arch anatomy.