Abstract 14079: Embolic Stroke Hemispheric Location is Highly Dependent of Aortic Arch and Cerebral Vessel Configuration
Background: The impact of aortic arch and cerebral branch vessel configuration on embolic stroke is poorly understood regarding predilection for left or right cerebral hemispheres. Cardioemboli have not been studied in this context since particle paths to the brain are difficult to observe or physically model. We examined aortic and cerebral branch anatomy on hemispheric embolic destination using subject-specific computational models.
Methods: Exact models of the human aorta and cerebral branch vessels (bilateral carotid/vertebral arteries) were derived from 3D CTA in 10 living patients. Blood flow was modeled by solving the Navier-Stokes equations using a validated flow solver. Embolic particles were mathematically injected at the aortic valve and tracked for cerebral hemispheric destination. Particle counts embolizing to the right and left hemispheres were determined as absolute percent, and percent normalized by respective hemispheric flow.
Results: 7 of 10 patients had separate cerebral ostia while 3 of 10 had bovine arch anatomy. Bovine arch was associated with 26 + 6% emboli to the right hemisphere, while separate ostia had 67 + 14% right hemispheric embolization, highly significant despite the small sample size (p<0.01). Absolute vs flow-normalized emboli percent showed litter difference.
Conclusions: Aorto-ostial cerebral branch configuration may impact left vs. right hemispheric stroke in cardioaortic embolic events. Aortic anatomy with separate ostia (about 66% of the general population) has a strong predilection for right hemispheric events, consistent with observational studies. Conversely, bovine arch (prevalence 27%) has a strong predilection for left hemispheric embolic events. This may occur since the innominate artery is the first cerebral branch, and the left common carotid artery in bovine arch has this same origin. Moreover, particulate incidence angle is more closely aligned with the left common carotid origin.
- © 2013 by American Heart Association, Inc.