Aortic Arch Typing Diagnosed by CT Angiography and Its Relationship with Ischemic Stroke

Year 2020, , 346 - 350, 25.12.2020

Hasan Bayındır , Sunay Sibel Karayol , Halil Ay

https://doi.org/10.35440/hutfd.769032

Abstract

Background: The radiological images of 379 patients with a diagnosis of ischemic stroke who were admitted to neurology department in one year are retrospectively analyzed, to determine the types and variations of the aortic arch, frequency and its relationship with localization of ischemic stroke.
Materials and Methods: Retrospectively examined, the brain magnetic resonance imaging (MRI), brain computed tomography (CT) and carotid vertebral CT angiographies of 379 patients who were admitted to neurology department between february 2017 and 2018 were diagnosed with ischemic stroke. Arcus aorta types, variations, frequency and their relationship with localization of ischemic stroke were determined.
Results: 219 (57.8%) of the 379 cases were male and 160 (42.2%) were female patients with ischemic stroke diagnosed by carotid vertebral CT angiography. 288 patients had Type 1, 80 patients had Type 2, and 11 patients had Type 3 archus aorta. 220 of all patients had infarction originating from the anterior system and 159 had infarction originating from the posterior system. There was also type 2 cases with an anterior system rate of 73.8%. In the evaluation made according to the anterior-posterior and left-right circulation distinction, left-anterior infarct originated from 30.9% of the Type1 archus case, 61.2% of the Type2 case, and 63.6% of the Type3 case were detected.
Conclusion: Infarcts arising from anterior system circulation are more common in all ischemic strokes. Type 1 was the most common in the archus aorta typing. It was observed that the anterior system originated infarcts were the most common in the Type 2 archus aorta and left-sided, and the infarcts from the posterior system were more frequent in the cases with Type 1 archus aorta, and these infarcts were observed more clearly in the right posterior circulation.

Key words: Aortic arch, types of aorta, arcus variations, ischemic stroke

Keywords

aortic arch,, types of aorta,, arcus variations,, ischemic stroke

Project Number

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BT Anjiyografi ile Saptanan Arkus Aorta Tiplendirilmesi ve İskemik İnme ile Olan İlişkisi

Abstract

Amaç: Bir yıl içerisinde iskemik inme tanısı ile nöroloji kliniğine başvuran 379 hastanın, radyolojik görüntülerini retrospektif olarak inceleyerek arkus aorta tiplerinin ve varyasyonlarının belirlenmesi, aorta tiplerinin sıklığının tespiti ve iskemik inmenin lokalizasyonu ile olan ilişkilerini araştırmaktır.
Materyal ve metod: Şubat 2017-2018 tarihleri arasında nöroloji kliniğine iskemik inme tanısı ile başvuran 379 hasta retrospektif olarak değerlendirildi. Beyin manyetik rezonans görüntüleri (MRG), beyin bilgisayarlı tomografi (BT) ve karotis vertebral BT anjiografileri incelendi. Arkus aorta tipleri, varyasyonları, sıklığı, iskemik inmenin lokalizasyonu ile olan ilişkileri belirlendi.
Bulgular: İskemik inme ile takip edilen ve karotis vertebral BT angiografi çekilen toplam 379 hastanın 219’u (%57.8) erkek, 160’ı (%42.2) kadın hastaydı. 288 hastada Tip1, 80 hastada Tip2 ve 11 hastada Tip3 arkus aorta mevcuttu. Çalışmaya katılan hastalardan 220’si ön sistem kaynaklı enfarkta, 159’u ise arka sistem kaynaklı enfarkta sahipti. Ön sistem enfaktı en çok %73,8 olarak Tip2 hastalarında vardı. Ön-arka ve sağ-sol dolaşım ayrımına göre yapılan değerlendirmede Tip1 arkuslu hastanın %30,9’unda, Tip2 arkuslu hastanın %61,2’sinde, Tip3 arkuslu hastanın %63,6’ünde sol-ön sistem kaynaklı enfarkt tespit edildi.
Sonuç: Tüm iskemik inmelerde ön sistem sirkülasyonu kaynaklı enfarktlar daha sıktır. Arkus aorta tiplendirmesinde ise en sık Tip1 tespit edilmiştir. Ön sistem kaynaklı infaktların en sık Tip2 arkus aortada ve sol taraflı olduğu, arka sistem kaynaklı enfarktların ise daha sık Tip1 arkus aortalı hastalarda olduğu ve bu enfarktların da sağ arka sistem dolaşımda daha belirgin olarak izlendiği göze çarpmıştır.

Anahtar Kelimeler: Aortik ark, Aort tipleri, Arkus varyasyonları, İskemik inme

Keywords

aortik ark, aort tipleri,, arkus varyasyonları,, iskemik inme

Supporting Institution

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Project Number

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Thanks

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References

• 1. Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE. Classification of subtype of acute ischemic stroke definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35-41.
• 2. Prabhakaran S, Ruff I, Bernstein R. Acute Stroke Intervention A Systematic Review. JAMA. 2015; 313 (14): 1451-1462.
• 3. Li S, Wena H, Liang M, Luoa D, Qin Y, Liao Y et all. Congenital abnormalities of the aortic arch: revisiting the 1964 Stewart classification. Cardiovascular Pathology. 2019;39: 38–50.
• 4. Natsis K, Tsitouridis I, Didagelos M, Fillipidis A, Vlassis K, Tsikaras P. Anatomical variations in the branches of the human aortic arch in 633 anigoraphies: clinical significance and literature review. Surg Radiol Anat. 2009;31(5):319-323.
• 5. Kellenberger CJ. Aortic arch malformations. Pediatr Radiol. 2010;40:876–884.
• 6. Kondori BJ, Asadi MH, Rahimian E, Tahsini MR. Anatomical Variations in Aortic Arch Branching Pattern. Archives of Iranian Medicine. 2016;19(1):72-74.
• 7. Rojas M, Muete W, Quijano Y. Anatomical variations of the aortic arch in a sample of Colombian population. Rev. Fav. Med. 2017;65(1):49-54.
• 8. Han J, Xiang H, Ridley W.E, Ridley LJ. Bovine aortic arch. Journal of medical imaging and radiation oncology. 2018;62(1):20-21.
• 9. Syperek A, Angermaier A, Kromrey ML, Hosten N, Kirsch M. The so-called "bovine aortic arch": a possible biomarker for embolic strokes? Neuroradiology. 2019;61(10):1165-1172.
• 10. Dumfarth J et all. In DeBakey Type I Aortic Dissection, Bovine Aortic Arch Is Associated With Arch Tears and Stroke. The annals of thoracic surgery. 2017;107(6):2001-2008.