Aortic Arch Types and Arch Anomalies in Patients Undergoing Carotid Endarterectomy

In this retrospective single-center study, the authors evaluated aortic arch anatomy in 532 consecutive patients undergoing carotid endarterectomy for carotid stenosis between 2020 and 2025. Preoperative computed tomography angiography demonstrated type I, II, and III arches in 49.4 percent, 34.6 percent, and 16.0 percent of patients, respectively; 50.6 percent had complex type II or III anatomy. Aortic arch anomalies were identified in 19.7 percent of patients, most commonly a bovine arch (16.2 percent), followed by a left vertebral artery arising directly from the arch (2.8 percent), an aberrant right subclavian artery (1.1 percent), and a right aortic arch (0.2 percent). The arch-type distribution differed significantly from a previously published reference population (p<0.001), primarily reflecting fewer type III arches. No demographic or clinical variable independently predicted the presence of an arch anomaly. These findings demonstrate substantial variation in aortic arch anatomy in this Eastern Mediterranean cohort and highlight its relevance to preprocedural planning when endovascular carotid intervention is considered.