Aortic Branching Research Articles

Morphological characteristics and outcomes of aortic repair of acute type A aortic dissection occurring in patients with aortic arch branching variants.

To investigate the morphological characteristics and operative outcomes of acute type A aortic dissection (ATAAD) in patients with aortic arch variants. Of 616 patients with ATAAD, 97 (15.7%) had aortic arch variants, including bovine aortic arch (BAA, n = 66), isolated left vertebral artery (ILVA, n = 25), and aberrant subclavian artery (ASA, n = 6). The characteristics and outcomes were compared between the normal branching group (control, n = 519) and the total/individual arch variant groups. Compared to the control group, arch entry was more prevalent in the BAA (18.5% vs. 31.8%) and ILVA groups (44%) (both, P < 0.05), and right common carotid arterial occlusion was less common in the arch variant group (6.7% vs. 0%, P = 0.017). The in-hospital mortality (9.2% vs. 9.3%), new-onset stroke (7.3% vs. 7.2%), and 5-year survival (81.7% vs. 78.8%) did not differ markedly between the control and arch variant groups. Arch repair was performed in 28.9% (28/97) of the arch variant group using 3-4 vessel antegrade cerebral perfusion, with 3.8% in-hospital mortality and a 15.4% stroke rate, which were comparable to those of the control group. Aortic arch variants may influence tear location and involvement of the supra-arch vessels but may not affect postoperative outcomes.

Vertebral arteria lusoria-Hyrtl's original description (1859), case illustration, and literature analysis.

A translation of the initial observation of vertebral arteria lusoria reported by Hyrtl in 1859 is followed by a review of all cases published until May 2023 to identify the anatomical and clinical features characterizing the typical form of this rare variant. PubMed, Google Scholar, and Google queries were performed with "vertebral arteria lusoria", "retroesophageal vertebral artery", and "aberrant vertebral artery" as keywords (in English, German, and French). A feature was considered typical when present in at least 75% of analyzed cases. A case of incidentally discovered vertebral arteria lusoria illustrates the typical form of the variant. The analysis of 56 publications yielded 66 observations of right-sided vertebral arteria lusoria published between 1859 and May 2023. A small caliber, a retro-esophageal location, and passage through the foramen transversarium of C7 were typical. There was no evidence of association with clinical symptoms or other cardiovascular anomalies. A typical vertebral arteria lusoria is an incidentally discovered nondominant aberrant right VA originating from the proximal descending aorta and following a retro-esophageal course to enter the C7 foramen transversarium, without associated aortic arch branching anomalies or congenital cardiovascular pathologies.

Common ostial origin of right subclavian artery and bicarotid trunk in two branch vessel left aortic archRare aortic arch branching pattern

Common ostial origin of right subclavian artery and bicarotid trunk in two branch vessel left aortic archRare aortic arch branching pattern

Aortic arch branching variations and risk of cerebrovascular accidents in patients with a left ventricular assist device.

This retrospective study investigated the association between anatomical variations in the aortic arch branching and adverse events, including the risk of cerebrovascular accidents (CVAs), in patients with a left ventricular assist device (LVAD). Medical charts were reviewed for all patients with HeartMate 3 LVAD support at our center from 2016 to 2021. Computed tomography scans were evaluated to categorize the variations in the aortic arch branching based on seven different types, as described in the literature. In total, 101 patients were included: 86 (85.1%) with a normal branching pattern and 15 (14.9%) with an anatomical variation. The following variations were observed: eight (7.9%) with a bovine arch and seven (6.9%) with a left vertebral arch. The median age was 57 years, 77.2% were men, and the median follow-up was 25 months. No difference was found in the rate of early (< 30 days) re-exploration due to bleeding after LVAD implantation. The rate of CVA and mortality did not differ significantly between patients with a normal arch or an anatomical variation during follow-up, with hazard ratios of 1.47 [95% confidence interval (CI): 0.48-4.48; P = 0.495] and 0.69 (95% CI: 0.24-1.98; P = 0.489), respectively. This preliminary study showed no differences in early and long-term adverse events, including CVA, when comparing patients with a variation in the aortic arch branching to patients with a normal aortic arch. However, knowledge of the variations in aortic arch branching could be meaningful during cardiac surgery for potential differences in surgical events in the perioperative period.

Evaluating AI-powered text-to-image generators for anatomical illustration: A comparative study.

Medical illustration, which involves the creation of visual representations of anatomy, has long been an essential tool for medical professionals and educators. The integration of AI and medical illustration has the potential to revolutionize the field of anatomy education, providing highly accurate, customizable images. The authors evaluated three AI-powered text-to-image generators in producing anatomical illustrations of the human skulls, heart, and brain. The generators were assessed for their accurate depiction of foramina, suture lines, coronary arteries, aortic and pulmonary trunk branching, gyri, sulci, and the relationship between the cerebellum and temporal lobes. None of the generators produced illustrations with comprehensive anatomical details. Foramina, such as the mental and supraorbital foramina, were frequently omitted, and suture lines were inaccurately represented. The illustrations of the heart failed to indicate proper coronary artery origins, and the branching of the aorta and pulmonary trunk was often incorrect. Brain illustrations lacked accurate gyri and sulci depiction, and the relationship between the cerebellum and temporal lobes remained unclear. Although AI generators tended toward esoteric imagery, they exhibited significant speed and cost advantages over human illustrators. However, improving their accuracy necessitates augmenting the training databases with anatomically correct images. The study emphasizes the ongoing role of human medical illustrators, especially in ensuring the provision of accurate and accessible illustrations.

Does Aortic Arch Anatomy Affect Stroke Laterality in Transcatheter Aortic Valve Implantation?

Background. Current data reveal a predominace of left as opposed to right-sided cerebral strokes after transcatether aortic valve replacement (TAVR). Aortic arch variations might raise the likelihood of cardioembolic particles entering predominantly the left cerebral circulation during catheter tracking and manipulation. Aim. We sought to analyse the impact of aortic arch anatomy on stroke laterality (right vs. left) in patients undergoing TAVR. Methods. All patients who developed a symptomatic, periprocedural left- or right-sided ischemic stroke after TAVR between June 2007 and August 2022 were included in this study. Multislice computed tomography (MSCT) analysis was used to assess aortic arch anatomy, arch configuration (types I–III), arch tortuosity, and the determination of the take-off angles of the supraaortic arteries. Results. The final study cohort comprised 77 patients. Periprocedural ischemic stroke was left-sided in 66.2% of the patients (n = 51) and right-sided in 33.8% (n = 26) (p = 0.006). MSCT analysis revealed a standard aortic arch branching pattern in 70.1% (n = 54) and a common origin of the brachiocephalic and left common arteries (bovine arch anatomy) in 29.9% (n = 23) of the patients. There was no association between the anatomical variations of the aortic arch and stroke laterality p = 0.601 . Frequency of arch configuration types was 15.6% (type I), 74.0% (type II), and 10.4% (type III). There was no correlation between the different types of configuration and the laterality of periprocedural stroke (type I: p = 0.526 , type II: p = 0.585 , and type III: p = 1.000 ). Aortic arch tortuosity and angulation of the supraaortic arteries did also not differ between right- and left-sided strokes. Conclusion. Our data add evidence that there is a significant propensity for left-hemispheric strokes in patients undergoing TAVR. However, MSCT analysis in our cohort did not reveal an association between aortic arch geometry and laterality of stroke.

Anatomical Variations in Aortic Arch Branching Pattern: A Computed Tomography Angiography Study.

Variations in the branching pattern of the aortic arch (AA) are common. Modification of intravascular stents should be considered taking into account these AA branching variations. Identification of supra-aortic branching types and frequencies is important for specialists planning surgery in this region.In endovascular interventions to the AA, aortic stent grafts should be modified according to the variations of the branching patterns of the AA.In any surgical intervention to the region where the supra-aortic branches are located, ignorance of the variations may cause unwanted injuries or complications. In this study, 699 computed tomography angiography (CTA) images were reviewed to investigate AA branching variations using the Horos software (an open-source image viewer). Four groups were constructed based on the number of branches emerging from the aortic arch, which were further divided into subtypes. A total of 699 CTA images from 320 males and 379 females were included in this study. The usual AA branching pattern (type 3b1) was found in 68.5% of the patients. The combined prevalence of other eight branching patterns, designated as variations, was 31.5%. Variation types 1b1, 3b2, and 4b5 were identified in one patient each. Overall, types 2b1 and 2b2 had a prevalence of 28.3%. The type 2b3 variation was observed in 1.6% of the patients. The least common variations were type 4b1 (0.7%) and type 3b2 (0.1%). The identification of variations in AA branching patterns by CTA prior to surgical or endovascular interventions involving the aortic arch is important. Thus, specialists planning interventions in this region need to be aware and have knowledge of atypical aortic branching patterns. Higher prevalence rates of AA branching patterns compared to previous studies were identified in the Turkish population in this study and therefore, a comprehensive, multicenter study is needed to determine the cause of this differential finding.

Single-cell transcriptomics uncovers a non-autonomous Tbx1-dependent genetic program controlling cardiac neural crest cell development

Disruption of cardiac neural crest cells (CNCCs) results in congenital heart disease, yet we do not understand the cell fate dynamics as these cells differentiate to vascular smooth muscle cells. Here we performed single-cell RNA-sequencing of NCCs from the pharyngeal apparatus with the heart in control mouse embryos and when Tbx1, the gene for 22q11.2 deletion syndrome, is inactivated. We uncover three dynamic transitions of pharyngeal NCCs expressing Tbx2 and Tbx3 through differentiated CNCCs expressing cardiac transcription factors with smooth muscle genes. These transitions are altered non-autonomously by loss of Tbx1. Further, inactivation of Tbx2 and Tbx3 in early CNCCs results in aortic arch branching defects due to failed smooth muscle differentiation. Loss of Tbx1 interrupts mesoderm to CNCC cell-cell communication with upregulation and premature activation of BMP signaling and reduced MAPK signaling, as well as alteration of other signaling, and failed dynamic transitions of CNCCs leading to disruption of aortic arch artery formation and cardiac outflow tract septation.

Association of the bovine aortic arch and bicuspid aortic valve with thoracic aortic disease

BackgroundBoth bicuspid aortic valve (BAV) and bovine aortic arch (BA) are considered as markers of thoracic aortic disease (TAD). But the association between them is not yet clear. This study aimed to explore the potential association of BAV and BA with TAD.MethodsThe study involved 449 participants who underwent their first aortic valve replacement in Fuwai Hospital from June 2017 to March 2018. All patients underwent multidetector computed tomography and echocardiography before surgery. The clinical characteristics were recorded to analyze the association between BAV, BA, and TAD. The univariate and multivariate logistic regression analyses were applied to identify the risk factors for TAD.ResultsBA accounted for 79.8% of the arch variants and was the most common aortic arch branching variant. BAV was present in 52.6% of the patients with BA and 38.1% of the patients with normal arch (NA). Among the 185 patients in the BAV subgroup, 50 had BA and 135 had NA. No significant differences were found in BAV anatomical phenotype, aortopathy phenotype, and valve function between BA and NA. The multivariate analysis showed that the presence of BAV and male sex were the risk predictors of TAD. BA was not a risk factor for TAD in either univariate or multivariate analysis.ConclusionsThe proportion of BAV in patients with BA was significantly higher than that of NA, but the BAV phenotype and aortopathy were not related to BA. BAV was a risk factor for TAD, whereas BA was not associated with TAD.

Correlation between Bovine Arch and Thoracic Aortic Disease: A Literature Review

The bovine artery is considered the most frequent aortic arch branching variation. Despite being considered a normal variation of the aortic arch branching, still it has been linked with various issues regarding the thoracic aorta. The aim of this study is to highlight the prevalence of bovine artery among specific vascular pathologies throughout the literature and to provide information to clinicians about the importance of identifying this variation. For this specific review, we acquired potentially relevant studies for inclusion from the electronic database of PubMed. We limited our investigation to papers published within the last decade (from 2011 to 2021). Single case reports, papers with language restrictions, letters to the editor, conference abstracts, studies that were non-human centered and studies with unextractable and incomplete data were not included. Searching the PubMed database, it was evident that there is a close relationship between bovine arch and thoracic aortic arch pathology. In the defined period 2011–2021 that our research was focused, we selected eight studies tackling this issue. The majority of the studies in this review (except one) provided concerning data about the prevalence of this aortic arch variant among patients with aortic aneurysmal dilatation and aortic dissection. Following our results, we strongly believe that bovine arch should no longer being considered as a normal variation with no clinical significance, but rather as a potential risk factor for thoracic aortic arch morbidities.

Aortic Arch Variations and Supra-aortic Arterial Tortuosity in Stroke Patients Undergoing Thrombectomy

PurposeUnfavorable vascular anatomy can impede thrombectomy in patients with acute ischemic stroke. The aim of this study was to determine the prevalence of aortic arch types, aortic arch branching patterns and supra-aortic arterial tortuosity in stroke patients with large vessel occlusion.MethodsComputed tomography (CT) and magnetic resonance (MR) images of all stroke patients in an institutional thrombectomy registry were retrospectively reviewed. Aortic arch types and branching patterns of all patients were determined. In patients with anterior circulation stroke, the prevalence of tortuosity (elongation, kinking or coiling) of the supra-aortic arteries of the affected side was additionally assessed.ResultsA total of 1705 aortic arches were evaluated. Frequency of aortic arch types I, II and III were 777 (45.6%), 585 (34.3%) and 340 (19.9%), respectively. In 1232 cases (72.3%), there was a normal branching pattern of the aortic arch. The brachiocephalic trunk and the left common carotid artery had a common origin in 258 cases (15.1%). In 209 cases (12.3%), the left common carotid artery arose from the brachiocephalic trunk. Of 1598 analyzed brachiocephalic trunks and/or common carotid arteries, 844 (52.8%) had no vessel tortuosity, 592 (37.0%) had elongation, 155 (9.7%) had kinking, and 7 (0.4%) had coiling. Of 1311 analyzed internal carotid arteries, 471 (35.9%) had no vessel tortuosity, 589 (44.9%) had elongation, 150 (11.4%) had kinking, and 101 (7.7%) had coiling.ConclusionWith 20%, type III aortic arches are found in a relevant proportion of stroke patients eligible for mechanical thrombectomy. Nearly half of the stroke patients present with supra-aortic arterial tortuosity, mostly arterial elongation.

A case of pulmonary artery sling, unilateral lung hypoplasia, and congenital heart disease

Vascular rings are rare congenital anomalies that primarily result from an embryological derangement of the paired aortic arches or branching pulmonary arteries. They make up &lt;1% of all cardiac defects. Double aortic arch and right-sided aortic arch with the left ligamentum arteriosum are the most common types, making up 85– 95% of cases, with pulmonary artery slings making up about 10% of cases. The prevalence is estimated as 59 per million children with very few cases reported worldwide. The clinical presentation is variable and this includes severe acute life-threatening episodes, recurrent apnea, severe respiratory distress, feeding difficulties persistent cough, wheezing, or stridor. In some cases, affected individuals may be completely asymptomatic. A high index of suspicion is needed to suspect and diagnose vascular rings as they are uncommon but surgically treatable. We present a case of a 5-day-old term neonate referred to our facility with respiratory distress associated with stridor which started 12 h post-delivery.

135 A prenatally diagnosed double aortic arch case

Introduction: According to theory by Edwards, it is accepted that in the embryo the aorta is divided into the right and left arches of the ascending aorta and merges with each other at the descending aorta level, and it is anatomically present in the form of a double aortic arch located in the central position at anterior of the spine. Thus, complete vascular ring is formed that surrounds the trachea and esophagus with left and right-sided archs. The right and left aortic arches are each divided into two vessels; these are the right and left common carotid and subclavian arteries, respectively. The left and right pulmonary arteries are connected to the right and left ductus arteriiosus in the subclavian arteries region and to the left and right sided aortic arches, respectively. Therefore, the normal or abnormal development of aortic arch branching depends on which of the left or right aortic arches will regress or continue during embryological development. Methods: In our case, two main vessels, one of which is hypoplasic, originating from the left ventricle, were observed in cardiac ultrasonography performed to the pregnant woman, who was referenced from an external center. Discussion: The patient was followed up by us and gave birth by normal vaginal route at 37 weeks of gestation and the baby was diagnosed with double aortic arch in postnatal MRG. The newborn was followed up by pediatric cardiologists. Conclusions: Double aortic arch anomaly is resulted from both right and left aortic arches maintaining their existence without regressing. While the left ductus arteriosus continues to exist, the right side regresses. Each aortic arch gives branch to a common subclavian and carotid artery. The double aortic arch creates a tight vascular ring around the trachea, which may require postnatal surgery.

Computed Tomographic Analysis of Aortic Arch Branching Patterns: Revisited

Branching pattern of aortic arch (AA) has a direct impact on the outcomes of thoracic surgical and angiographic procedures. Since, geographical variations in the branching pattern of AA have been described, this descriptive cross-sectional study describes the AA variations in a Sri Lankan population compared to the available global data. For that, contrast-enhanced computed tomographic studies (CTC) of thorax (n = 219) performed in males (49.3%) and females (50.7%), aged 59 ± 17 years (range: 4 to 96 years), were evaluated. Branching patterns of AA were categorized into seven types as described by Popieluszko et al. Only, four AA types were identified in the study population: type 1 (90%; n = 197), type 2 (n = 10, 4.6%), type 3 (n = 8, 3.7%), and type 6 AA (n = 4; 1.8%). The prevalence of AA variations was 10%. Type 1 AA was the most prevalent pattern in both genders: female, 91%; males, 88.9%. The most prevalent AA variant in females was type 2 (n = 6; 5.4%); males type 3 (n = 5; 4.6%). However, the branching pattern of AA has not demonstrated a significant gender influence (odds: 0.792; 95% CI: 0.327–1.917; p = 0.605). Variations in branching pattern of AA are as high as 10% among Sri Lankans. Thus, an in-depth knowledge on population specific prevalence of AA variants would influence the modifications of surgical approaches and the choice of angiographic catheters to be utilized, which in turn would minimize inadvertent vascular injuries during thoracic surgical and angiographic interventions.

CT Angiographic Study of Anatomical Variations of Aortic Arch Branches in Libyan Patients

The aim of this study is to determine the prevalence of the aortic arch branches variations in Libyan patients. The proportion of each type will be determined. Subjects and methods: This retrospective study was carried out on 229 cancer patients referred to the CT Scan Department for enhanced chest CT scanning. The scans showed that 83% of the patients had classical aortic arch branching patterns, and 17% had aortic arch variations. Bovine arch variation was the most common variation seen, reaching 11.4%, in which brachiocephalic and left common carotid arteries arise from the aortic arch in a common trunk. The prevalence of the left vertebral artery type that originates from the aortic arch was 3.9%. The prevalence of the aberrant right subclavian artery type was 2.6%, and of the aberrant right subclavian artery with common carotid trunk type was 1.74%. No relationship was found between gender and aortic arch branches variations. We conclude that aortic arch branching variations exist and hence, attention must be paid during chest surgical operations/radiological interventions to ensure safe procedure outcomes. Also, a CT scan is a good method to study such variations and the associated branching patterns.

English

A bovine aortic arch is the most common variant of aortic arch branching in humans with a frequency ranging from 15 to 27% (1-2). It will be considered as a risk factor for aortopathy as anevrysm and dissection. Two cases were reported with association of bovine aortic arch and aortopathy. In both cases, the discovery of the anomaly of the aortic arch was fortuitous. A bovine aortic arch is frequent in patients with thoracic aortic disease than in the general population with a rapid evolution on the diameter of the aorta which expose patients to more complications such as anevrysm, rupture and dissection. It will be considered as a risk factor for aortopaty. Key words: Bovine aortic arch, aortopathy, common birth aortic arch.

Branching patterns and anatomical variations of human aortic arch in Indian population

Knowledge of the aortic arch branching pattern is important during supra-aortic angiography, aortic instrumentation, thoracic and neck surgery. The aortic arch (AA) is located in the superior mediastinum. In 65–80% of the cases, the three branches arise from the aortic arch, namely, the brachiocephalic trunk (BCT), the left common carotid artery (LCCA), and the left subclavian artery (LSA). The purpose of this study is to describe different branching patterns of the arch of the aorta in Indian subjects. This observational study is based on dissection performed on Sixty embalmed arches of the aorta in adult Indian cadavers (in manuscript it was written as, 20 dissected heart specimens were collected of still-born fetuses) were exposed and their branches examined during cadaveric dissection in the department of Anatomy. The anatomical variations of the arch of the aorta and its branches, its branches at site of origin, and the distance of each branch from the point of origin to the median plane were measured. The usual three-branched pattern of arch of aorta was found in 44 specimens (73.33%). The common trunk for both brachiocephalic trunk and left common carotid artery was present in 11 specimens (18.33%). In 2 specimens (3.33%), the arch gives four branches. In 1 specimen (1.67%), give three branches. The wide spectrum of variations in the anatomical arrangement of the human aortic arch and its branches offer valuable information to catheterize the aortic arch and its branches for safely performing endovascular surgery. These anatomical and morphologic variations in the arch of the aorta and its branches are significant for diagnostic and surgical procedures in the thorax, head and neck regions.

Anatomical variations of the aortic arch branching pattern using CT angiography: a proposal for a different morphological classification with clinical relevance.

The aortic arch (AA) branching pattern variations are usually asymptomatic, but they may lead to complications during cardiovascular procedures. In this retrospective study, we aimed to analyze the frequency of anatomical variations of the AA and to develop a different approach of morphological classification based on radiological criteria. 1026 computed tomography angiography scans of adults were evaluated and the presence of left-sided (LAA) and right-sided (RAA) AA were determined in 1023 (99.71%) and 3 (0.29%) of patients, respectively. According to the number of branches, LAA branching pattern of each patient was subclassifed in five morphological types. Based on the order and type-specific reference points, an anomalous LAA variants were classified into 20 subtypes. Type 1 (Typical branching pattern) LAA was identifed in 781 (76.12%) of the patients. Among 242 aberrant LAA variants (four types, 23.58%), the most common subtypes; Type 2A with brachiocephalico-carotid trunk (BCT), Type 4A1 with an aberrant left vertebral artery (ALVA), and Type 3A1, in which BCT coexisted with ALVA, were observed in 17.6%, 3.6%, and 0.88% of the cases, respectively. The frequency of remaining LAA variants ranged from 0.39% to 0.097%. In addition, Type 3B2 and Type 4C were first identified in our study. We observed Type I and II RAA in one female (0.097%) and two cases (male and female, 0.19%), respectively. Knowledge of AA branching variations is of great interest in neck and thoracic surgery and the new morphological types in clinically applicable form recommended in this study can be used in endovascular interventions.

Morphometry of the aortic arch and its branches. A computed tomography angiography-based study.

The current study aims to determine the prevalence of variations of the aortic arch using computed tomography angiography (CTA), as well as morphometries and gender correlations. A retrospective, transverse, observational and descriptive study of 220 CTA was performed. The branching pattern, most cranial vertebral level of the aortic arch, area of the proximal, middle and distal segments of the arch, area of each branch, and the path of atypical arteries were recorded. Results were analysed and stratified by gender. The typical aortic arch branching pattern was present in 77.7% without statistical significance between genders. The most common variant was a two-branch pattern with a common trunk and a left subclavian (13.6%), followed by a typical branching pattern with an added left vertebral artery (7.3%). T3 was the most frequent cranial level (32.3%), followed by T2-T3 (26.8%), and T3-T4 (23.2%). The mean areas of the aortic arch were 685.5 ± 183.9, 476.1 ± 124.1, and 445.0 ± 145.1 mm2 for the proximal, middle and distal segments, with statistical difference between men and women in the middle and distal segments. Three paths of atypical arteries were identified: bifurcated vertebral artery (0.5%), aberrant right subclavian artery (0.5%), and left subclavian ostium obstruction (0.5%). Mexican population has one of the highest prevalence of variations in the aortic arch branching pattern. The high probability of finding these should be taken into consideration when assessing patients. A standardised classification method would contemplate future un-reported findings, without causing confusion by the different numbers assigned by each author.

Investigating the Association between Aortic Arch Variants and Intracranial Aneurysms.

There is an association between anterior cerebral artery vessel asymmetry and anterior communicating artery aneurysm, presumably based on flow dynamics. The purpose of this study is to investigate the potential relationship between aortic arch branching patterns and incidence of intracranial aneurysm. This study included patients scanned over 1 year at our tertiary care center who underwent high-resolution imaging (computed tomography angiography or digital subtracted angiogram) of the head and neck arteries, aortic arch, and superior mediastinum. Exclusion criteria included patients with suboptimal images. Patient age, gender, aortic arch branching pattern, and the presence, location, and number of aneurysms were documented. Among the 1082 patients analyzed, 250 (23%) patients had a variant aortic arch branching pattern, 22 (8.8%) of whom had aneurysms. There were 104 patients with 126 aneurysms, with majority of patients with normal aortic arch branching pattern (n = 82, 79%). The most common variant was a common origin of the left common carotid artery and brachiocephalic trunk with or without direct origin of the left vertebral artery. Twenty-two patients with aneurysms had an aberrant aortic arch (21%), compared to 232 patients without an aneurysm (24%). Fischer exact test showed no statistically significant difference between the incidence of aneurysm with different aortic arch variant groups (two-tailed p-value = 0.715). To our knowledge, this is the first study to examine the association between aortic arch branching patterns and incidence of intracranial aneurysm. No significant association was found between aortic arch branching pattern and the incidence of intracranial aneurysm.