Right–Left Propensity of Cardiogenic Cerebral
Embolism in Standard versus Bovine Aortic
MENACHEM GOLD ,
* MOJDEH KHAMESI,
Department of Radiology, Lincoln Medical Center, Bronx, New York
Department of Internal Medicine, Lincoln Medical Center, Bronx, New York
Department of Emergency Medicine, Lincoln Medical Center, Bronx, New York
Left-hemispheric ischemic strokes are more frequent overall and often have a
worse outcome than their right-hemispheric counterparts. We hypothesized
that the right-left propensity of CE cerebral infarcts differs between patients
with standard and bovine arch variants. We retrospectively identiﬁed all
patients with acute stroke of the anterior circulation admitted to our primary
stroke center between January 2011 and June 2017 who had moderate- to
high-risk cardio-embolic sources according to the SSS-TOAST classiﬁcation.
From amongst these patients, only those with available cross-sectional imaging
of the aortic arch were included. Lesion side and patterns on diffusion-
weighted magnetic resonance imaging were determined blinded to the aortic
arch imaging. One hundred and nineteen patients met the TOAST criteria for
moderate- or high-risk cardio-embolic source. Of these, 58 (49%) were men
and the median age was 71.9 years; 33% of the patients had a bovine arch.
The most common etiologies of CE were atrial ﬁbrillation (n 5 80 [67%]) and
congestive heart failure with ejection fraction <30% (n 5 18 [15%]). In patients
with bovine arch there was an approximately 50% chance of having a right- or
left-sided infarct. Although there was a trend towards right-sided lesions in
patients with standard arches, this did not reach statistical signiﬁcance. No sta-
tistically signiﬁcant difference in embolic stroke laterality was demonstrated in
our relatively small sample. Bovine arch could be an independent risk factor for
cardio-embolic embolism. Clin. Anat. 31:310–313, 2018.
2018 Wiley Periodicals, Inc.
Key words: bovine arch; cerebral embolism; infarct
Left-hemispheric ischemic strokes are more fre-
quent overall and often have a worse outcome than
their right-hemispheric counterparts (Hedna et al.
2013). There are conﬂicting reports about the left–
right propensity of cardiogenic embolic (CE) infarcts
andez et al. 2003; Kim et al. 2011).
The laterality of cardiogenic cerebral embolization
could be affected by anatomical and rheological char-
acteristics of the aortic arch.
The most common aortic arch branching pattern,
found in approximately 65% of the population (Lippert
and Pabst, 1985), consists of three great vessels origi-
nating from the arch. The most frequent variant in
this branching pattern is a common origin of the bra-
chiocephalic and left common carotid arteries. The
*Correspondence to: M. Gold, MD, Department of Radiology,
Lincoln Medical Center, 234 E. 149th St, Bronx, NY 10451.
Received 8 November 2017; Revised 1 January 2018; Accepted
8 January 2018
Published online 25 January 2018 in Wiley Online Library
(wileyonlinelibrary.com). DOI: 10.1002/ca.23045
2018 Wiley Periodicals, Inc.
Clinical Anatomy 31:310–313 (2018)