What is the true incidence of anomalous bovine left common carotid artery configuration?

Background: Earlier studies have indicated that bovine left common carotid artery configuration occurs in 10.2-22% of patients and increases the complexity of navigating endovascular devices in the aortic arch. However, we anecdotally noted a higher incidence of bovine arch among angiosuite outpatients in Los Angeles, California. Thus, we retrospectively reviewed aortic arch angiograms performed in 93 unique outpatients to determine the true incidence of this anomalous configuration.

Methods: We were able to obtain complete angiographies from clinical data on 90 patients (mean age 50 years, SD 15.23 years, range 17-88 years) from May 2006 to January 2012. Angiograms were categorized as: normal arch; bovine arch with brachiocephalic trunk; bovine arch with common trunk; or indeterminate.

Results: The findings indicated an overall 35.16% bovine arch incidence, of which 78.13% is bovine arch with common trunk and 21.88% is bovine arch with brachiocephalic trunk. There was a higher prevalence in the women (40%, n = 60) than men (26.67%, n = 30). Caucasians had a lower incidence of bovine arch (27.78%, n = 47) compared with other ethnicities. The prevalence of bovine arch in different ethnicity and gender groups was assessed and the differences were not statistically significant.

Conclusions: The incidence of bovine left common carotid artery is higher than previously reported and varies by gender and race. Advanced knowledge of the high prevalence of this anomaly could reduce the risks and increase the efficiency of navigating catheters through the tortuous vessels during endovascular procedures. The clinical implications of this report warrant further investigation.