Assessment of Aortic Arch Morphology for Endovascular Interventions

Abstract

Abstract Introduction : The aim of this study was to retrospectively classify the aorta according to the location of the supra-aortic vessels and analyze the aortic arch angle and angulation of supra-aortic branches on Multidetector Computed Tomography (MDCT) images, and contribute relevant data to the literature for use by interventional radiologists, neurologists, and cardiovascular and head-neck surgeons. Our secondary aim was to support the development of the “custom-made” thoracic stent grafts with the help of new data from the current study. Materials and Methods A total of 311 images (from 141 females and 170 males) that best suited our purpose were selected through archive screening. After creating three-dimensional reconstructions of the MDCT images, the aortic arch was divided into types according to the location of the brachiocephalic trunk. All images were viewed in the oblique coronal plane, where the angulation of the aortic arch and its branches can be best seen and measurements were obtained. Aortic arch types and angles were examined by age and sex. Results When the sex distribution of the aortic arch types was examined, Type 2 aortic arch was more common in males and Type 1 was more common in females. Regarding the age distribution of the aortic arch types, Types 1c and 2d were found only in the 18–44 age group and Types 3a and 3b were only detected in individuals over the age of 65. These findings suggest that aortic arch configuration changes with advancing age. Analysis of the relationship between age and vessel angulation showed only a weak positive correlation between age and aortic arch angle. Aortic arch angle showed a weak negative correlation with the angulation of supra-aortic vessels but a weak positive correlation was found among the angles of supra-aortic branches (p < 0.05; r < 0.4). A significant difference between sexes was observed in terms of the left subclavian artery angle and left common carotid artery angle, which were greater in males than in females (p < 0.05). Conclusion Variations in the angulation of the aortic arch and supra-aortic branches may trigger stroke by causing hemodynamic abnormalities. We believe that our findings may help the design of endograft used for endovascular arch repair.