Aortic calcification on plain chest radiography predicts embolic complications during carotid artery stenting

Aortic arch calcification (AC) on conventional angiograms has recently been shown to be associated with embolic complications during carotid artery stenting (CAS). Because conventional angiography is not routinely carried out in patients prior to CAS, a less invasive, commonly available diagnostic modality is warranted to identify AC. We investigated the occurrence of AC on routinely acquired chest radiographs and its influence on diffusion-weighted imaging (DWI) lesions as surrogate markers for stroke.

A total of 152 patients (mean age: 67.5±8.9 years, 112 men) underwent CAS and completed pre- and post-procedural DWI. AC larger than 1cm in length was classified as relevant and could be detected in 63 patients (41.4%) on plain chest radiographs. In patients with AC significantly more new DWI-lesions were found than in patients without AC (median 2; interquartile range (IQR): 0–7 vs. median 1 IQR: 0–2; p<0.05). After multivariate regression analysis, AC was independently associated with new postprocedural DWI lesions.

AC is a common finding in patients with a high-grade carotid stenosis and predicts embolic complications during CAS. Since AC can be detected on plain chest radiography, this diagnostic tool is useful to identify high-risk patients for CAS.