A Study Of The Aortic Arch Form Impact On Carotid Artery Interventional Therapy

Part I:Analysis of the factors effecting the aortic arch morphologyObjective:To explore the application value of computed tomography angiography in the aortic arch anatomical morphology, and analysis the major factors effecting the aortic arch morphology.Methods:Retrospective analysis the records of 1254 patients underwent computed tomography angiography(CTA) of intracranial and cervical arteries at CT Room of The First Affiliated Hospital of Henan University between September 2011 and December 2013 consecutively. The aortic arch morphology of patients were classified according to Myla classification into Myla I, II and III. General clinical data of all patients were reviewed, and then analysis its relationship between the types of aortic arch.Results:Of the 1254 patients, 580(46.3%)were Myla I, 427( 34.1%) were Myla II, 247(19.7 %) were Myla III. Among the young group(≤45y), Myla I, II and III were found in 208(70.2%), 72(24.3%)and 16(5.5%)cases respectively. Among the middle-aged group(46-59y), 260(52.4%)cases were Myla I, 179(36.1%)cases were Myla II and 57(11.5%)were Myla III. And among the elderly group(≥60y), the number were 112(24.2%), 176(38.1%)and 174(37.7%)respectively. In the three types of aortic arch(type I, II and III), the number of patients combined with cerebrovascular disease were 336, 257 and 156;Hypertension were 295, 367, 212; Patients with diabetes mellitus complications were found in 285, 220, 113 cases respectively; A history of hyperlipidemia:319 cases in Myla I, 237 cases in Myla II and 133 cases in Myla III. 693 patients were former smokers, in which 320 cases were type I arch, 236 cases were type II arch and 137 cases were type III arch. Of all the patients, 467, 347, and 201 patients had comorbidities of coronary heart disease(CHD), and 394, 283, 166 patients had a family history of cardiovascular disease in Myla I, II and III respectively.Conclusions:1. Myla I was decreased with age, however, Myla II and III increased gradually. 2. Blood pressure has an effect on the aortic arch morphology. 3. Computed tomography angiography(CTA) can accomplish a detailed evaluation on the aortic arch morphology.Part II:Analysis the effect of the aortic arch morphology on carotid arteryinterventional therapy.Objective:To explore the effect of the aortic arch morphology on carotid artery interventional therapy.Methods:We retrospectively analyzed 224 patients of Fuwai hospital undergoing carotid artery stenting(CAS) between January 2011 and December 2012 consecutively;Results:Of the 224 cases, 7(3.1 %)were Myla I, 113( 50.4%) were Myla II, 104(46.4 %)were Myla III. the X-ray exposure time of Myla I, II and III aortic arch was 7.6±1.1min、9.4±1.5min and 14.1±5.1min. The dosage of contrast agent was 84.3±5.4ml、93.0±13.8ml and 130.1±31.3ml. In type III arch, the X-ray exposure time was longer, dosage of contrast agent were more, compared with type I and II arch(P<0.05). The complications(minor stroke 5 cases,major stroke 4 cases, myocardial infraction 1 case, contrast induced nephropathy 23 cases, death did not occurred) occurred in type III arch during perioperative period(22.1%) were higher than type I arch(0%) and type II arch(8.9%)(p=0.007).Conclusion:Aortic arch type is the influential factors of the technical indicators in carotid artery stenting. The difficulty and complications of carotid artery stenting increased in type III arch. Part III:Analysis the technique factors of carotid artery interventional therapyin Myla III aortic arch.Objective:To explore the technique methods to overcome the influence the Myla III aortic arch on carotid artery interventional therapy.Methods:We retrospectively analyzed 224 patients of Fuwai hospital undergoing unilateral carotid artery stenting(CAS) between January 2011 and December 2012 consecutively. operation related technique in carotid artery stenting were recorded. The retracement, turn and insertion of the catheter was technology 1. The retracement, turn of catheter and the guidance of guide wire were technology 2, The retracement, turn of catheter and the guidance of guide wire and the supporting of another catheter were technology 3, The use of special catheter and the guidance of guide wire and the supporting of another catheter were technique 4. Technology 1 and technology 2 were routine skills; Technology 3 and technology 4 were speciial skills. Aortic arches were classified into 3 types(Myla I, II and III)according to Myla classification.Results:Of 104 cases of patients with type III arch,48(46.2%) used speciial skills,which was significantly higher than that in type I arch 1(14.3%) or type II arch 17(15.0%)(P<0.05); In Myla III, 36(34.6%) cases applied technology 3, and 12(11.5%) cases applied technology 4. Of which 8 CAS were successful and 4 CAS were unsuccessful; The failure rate of Myla III arch(3.8%) is higher than type I arch(0%) and type II arch(0%)(p=0.045).Conclusion:The difficulty of carotid artery stenting increased in type III arch,Need to apply more instruments and techniques. Even so, some patients also difficult to operation is successful, so the difficulty of the treatment of patients with type III bow can change other strategy, to mitigate and reduce the risk to patients.