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PVSS2. Increased Aortic Arch Calcification In Patients Over 75 Years: Implications For Carotid Angioplasty And Stenting In Elderly Patients

Hernan A. Bazan, Hamid Mojibian, Sanjeev Pradhan, Alan Dardik.
Yale University School of Medicine, New Haven, Conn.

OBJECTIVES: Recent studies reveal consistently higher periprocedural risk of stroke during carotid angioplasty and stenting (CAS) in octogenarians yet the mechanisms for this increased risk are poorly understood. We analyzed aortic arch calcium content to determine whether it is influenced by age, arch type or patient comorbid conditions.

METHODS: Aortic arch calcium content and arch classification were examined in consecutive patients undergoing CT scans with aortic dissection protocol. Aortic arch calcium content was determined using a coronary calcium score (Vitrea 2.0); arch classification was determined by multiplanar reconstruction. ANOVA and multivariable logistic regression were used to determine statistical significance.

RESULTS: Aortic arch calcium content increased by decade (n=94), age <50: 12.6±12.3; age 50-59: 14.6±8.2; age 60-69: 276±120; age 70-79: 1,382±366; age over 80: 3,889±778 (p<0.001). There was significantly more arch calcium in patients over 75 years compared to younger patients (2,458±447 vs. 145±49, p<0.001). Patients with type II aortic arches had higher calcium content compared to type I aortic arches (2,028±546 vs. 712±191, p=0.01). Age, but not diabetes or other risk factors, predicted arch calcium content (p=.002).

CONCLUSIONS: Patients over 75 years have significantly more aortic arch calcification compared to younger patients. Increased arch calcium and type II arches may be markers of increased potential for embolization during endovascular manipulation of the aortic arch. Preprocedural determination of arch morphology and calcification may help determine which elderly patients are at increased risk for stroke during CAS.