Stroke and the Bovine Aortic Arch: Incidental or Deliberate? A Comparative Study and our Experience

Aim and Objectives: We aimed to find the prevalence of bovine aortic arch in stroke and non-stroke patients and to study the relationship between bovine aortic arch and the occurrence of stroke. Materials and Methods: One hundred patients with and without stroke underwent computed tomography (CT) angiography of the thoracic aorta and its arch. Fifty diffusion-weighted magnetic resonance imaging (MRI)-confirmed anterior circulation stroke patients who had undergone digital subtraction angiography (DSA) afterward formed the case group. As controls, another 50 patients who had thoracic CT angiograms for disease other than stroke during this time period were randomly selected. Demographics and prevalence of bovine arch were compared between cases and controls. In the case group, demographics and prevalence of bovine arch variants and their relationship to stroke were studied. Results: Prevalence of bovine aortic arch variant in anterior circulation stroke was 22%, compared to 6% in non-stroke patients (P = 0.043). The bovine aortic arch was associated with the younger onset of stroke occurrence (P= 0.046). In the bovine arch group, the proportion of left-sided strokes (P= 0.022) and bilateral strokes (P < 0.00001) was significantly higher. As compared to type A (P = 0.140), type B bovine aortic arch had a better association (P = 0.092). Conclusions: Bovine aortic arch is a risk factor for young-onset anterior circulation stroke. Bilateral and left-sided infarcts were more common. Endovascular procedures are difficult to perform through conventional routes, so brachioradial access is preferred.