3D Printing of Carotid Artery and Aortic Arch Anatomy: Implications for Preprocedural Planning and Carotid Stenting.

Background: Carotid artery stenting (CAS) has been associated with increased periprocedural stroke in comparison with carotid endarterectomy (CEA). Three-dimensional (3D) printing of aortic arch and carotid artery may aid with preprocedural planning and adaptive learning, possibly reducing procedure-related complications.

Methods: Five CAS cases with available computed tomography angiography (CTA) were retrospectively evaluated and 3D-printed models (3D-PMs) were made. One additional case that was 3D printed preprocedurally provided prospective analysis. Standard 3D printing software was used to create a computer-aided image from CTA series that were 3D printed. The models were painted with acrylic paint to highlight anatomical features. The type of aortic arch, common carotid artery (CCA) to internal carotid artery (ICA) angle, and ICA distal landing zone for embolic protection device (EPD) were analyzed. In addition, stent and EPD sizing was determined preprocedurally for the prospective case. Comparisons of 3D-PM were made with 3D-CTA reconstruction and carotid angiography.

Results: Of 6 cases, 2 had type III and 4 had type I aortic arches. One case, a failed endovascular approach from femoral artery access site requiring reattempt via right brachial artery, had a CCA to ICA angle >60° and a tortuous innominate artery and distal ICA for EPD. The remaining 5 cases had straight distal landing zones for EPD and <60° CCA to ICA angles with successful first endovascular attempt. Additionally, vessel-specific stent and EPD sizing was appropriately chosen for the 1 prospective case.

Conclusions: 3D-PM for CAS offers added value compared with CTA by providing improved perceptual and visual understanding of 3D anatomy.