A tailored approach to overcoming challenges of a bovine aortic arch during left internal carotid artery stenting.

PurposeTo investigate the efficacy and safety of a tailored approach to fit access and engagement techniques to the individual arch anatomy in patients with bovine-type aortic arch (BTAA) to overcome the perceived increased risk of technical failure and cerebral embolization during left internal carotid artery (LICA) stenting.MethodsThirty-five high surgical risk patients (23 men; mean age 68.6 years, range 62–90) with BTAA and LICA stenosis underwent carotid artery stenting (CAS). Left common carotid artery (LCCA) engagement was achieved by means of different techniques according to the configuration of the BTAA, arch type (I, II, or III), and angle between the innominate artery and the LCCA. The clinical, anatomical, and procedural data were retrieved from a prospectively maintained database and analyzed retrospectively to identify technical modifications required during the procedure compared with planning.ResultsThe technical success rate was 100%. Transfemoral access was used in 21 (60%) cases. In th...