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Carotid Artery Anatomy: Age Related Changes

OBJECTIVES:
With the increased acceptance of carotid stenting in carotid artery disease new concerns about the anatomical variants of the aortic arch and carotid arteries that might interfere with carotid artery stenting has arised. We reviewed all carotid angiograms evaluating for factors contributing for anatomical variations in the carotid anatomy.
METHODS:
Carotid angiograms from the period from 2003 to 2006 were reviewed. They were evaluated for: aortic arch variations, type of aortic arch, tortuosity of the common carotid artery and the internal carotid arteries proximal an distal carotid artery disease. Such factors were correlated with patient’s age. Comparison was made using Chi squared test.
RESULTS:
251 angiogram were reviewed in the period form the 2003 until 2006. Type I aortic arch was present in 87 ( 34.7%) patients, class II in 125 (49.8%) and class III in 31 (12.4%) patients. Bovine arch was present in 49 (19.5%) patients.
High bifurcation of the common carotid defined as bifurcation at or higher than C2 was present in 13 patients (5.2%). Vertebral arteries originating from the aortic arch were present in 6 (2.3%) patients.
Tortuosity of the proximal common carotid artery was present in 41 out of 46 (89%) patients 80 years of age or older as compared to 91 of 142 (64.1%) patients younger than 80 years of age ( p<0.01). Distal internal carotid artery tortuosity was present in 35 out of 48 (72.9%) patients 80 years of age or older compared to 86 out 169 (50.9%) patients younger than 80 years of age ( p<0.01). Level III arch showed no difference between both age groups (16.6% vs 13.15%).

CONCLUSIONS:
Carotid arteries showing changes with age including increase tortuousity of the common carotid arteries and internal carotid arteries which is associated with technically more difficult carotid artery stenting. This may explain the reported higher incidence of neurological complications associated with carotid artery stenting in patients 80 years of age or older .