Predictors of unfavorable aortic arch anatomy on computed tomography angiography in patients with stroke risk factors

CONTEXT: Identifying clinical variables associated with unfavorable aortic arch anatomy (AAA) is a seldom explored area with a high potential to increase endovascular stroke treatment safety, success, and efficiency. AIMS: This study aims to explore the association between clinical variables and the occurrence of unfavorable AAA in patients with stroke risk factors (SRFs). SETTINGS AND DESIGN: This is a retrospective cross-sectional study of computed tomography (CT) angiographies and electronic health records data. SUBJECTS AND METHODS: The study involved classifying AAA into favorable (type I) or unfavorable (type II/III) categories using three-dimensional reconstructions. Unfavorable anatomic anomalies were bovine configuration, tortuosity, coiling, kinking, and atherosclerotic plaque. STATISTICAL ANALYSIS USED: Clinical and laboratory variables were analyzed to identify predictors of unfavorable AAA through logistic regression. RESULTS: We report data from 108 CT angiographies; 81 (75%) showed unfavorable AAA (49 were type II and 32 were type III). Images belonged to 108 patients (mean age 68.1 ± 13.8 years), and 57 (52.8%) were females. The most common SRF was hypertension (70.4%, with a mean duration of 7.64 years). Participants with unfavorable AAA had higher serum creatinine (0.91 ± 0.18 vs. 0.81 ± 0.13, P = 0.002). Unfavorable AAA was associated with three predictors: serum creatinine (odds ratio [OR] 5.0, 95% confidence interval [CI] 1.9–8.4), duration of hypertension (OR 0.11, 95% CI 0.03–0.20), and duration of hypertriglyceridemia (OR -0.31, 95% CI -0.62 – -0.07). CONCLUSIONS: This study found that unfavorable AAA and anatomic anomalies are highly prevalent in patients with SRF. The results suggest three variables independently associated with unfavorable AAA.