Overall, 32% of the patients had type 1 arch, 29.1% type 2 arch, 15% type 3 arch, 13.6% type 1 bovine arch
, 5.8% type 2 bovine arch
, and 3.9% type 3 bovine arch
We report our experience in stenting of the left internal carotid artery (LICA) in patients with bovine arch, in which right brachiocephalic and left carotid share a common trunk from the aortic arch1.
The bovine arch introduces new challenges to the procedure.
CT angiography neck confirmed the lesion in Left carotid bulb causing 70-80% stenosis but missed to show bovine arch anatomy.
JB 3 diagnostic catheter was used to define the anatomy of the left carotid which showed a bovine arch in figure.
Choose the Appropriate Access Route in Bovine Arch and You Will Turn a Complex Left Carotid Artery Stenting Procedure Into a Simple One.
The black arrow shows the left subclavian entering the right brachiocephalic trunk (the bovine arch
The optimal treatment choice remains complex and debatable, in particular when these lesions are associated with the most common anatomical variant of the aortic arch branching, the so-called "bovine arch." The more usual subtype is described as the common origin of the brachiocephalic and left common carotid arteries and can occur in as many as 20% of patients [5, 6].
This paper suggests that the retrograde carotid kissing stenting with surgical cerebral protection could be a safe and effective solution to treat proximal MSSVs, especially in case that the use of the endovascular transfemoral approach is difficult because of the presence of potential embolic lesions and bovine arch.
Veselka, "Bovine arch," Archives of Medical Science, vol.
Eisenhauer, "Carotid stenting in the bovine arch," Catheterization and Cardiovascular Interventions, vol.