Carotid artery stenting in difficult aortic arch anatomy with or without a new dedicated guiding catheter: preliminary experience

Eur Radiol. 2013 May;23(5):1420-8. doi: 10.1007/s00330-012-2708-7. Epub 2012 Nov 18.


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.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aorta, Thoracic / abnormalities*
  • Aorta, Thoracic / diagnostic imaging
  • Aorta, Thoracic / surgery*
  • Blood Vessel Prosthesis*
  • Carotid Arteries / surgery*
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / surgery*
  • Catheterization, Peripheral / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Prosthesis Implantation / methods
  • Radiography
  • Stents*
  • Surgery, Computer-Assisted / methods
  • Treatment Outcome