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

ABSTRACT

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.