Aortic arch anomalies, embryology and their relevance in neuro-interventional surgery and stroke: A review

Shilpa S. Mantri, Bharath Raju, Fareed Jumah, Michael S. Rallo, Anmol Nagaraj, Priyank Khandelwal, Sudipta Roychowdhury, David Kung, Anil Nanda, Gaurav Gupta

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


Background: Congenital aortic arch anomalies are commonly encountered during neurointerventional procedures. While some anomalies are identified at an early age, many are incidentally discovered later in adulthood during endovascular evaluations or interventions. Proper understanding of the normal arch anatomy and its variants is pivotal to safely navigate normal aortic arch branches and to negotiate the catheter through anomalies during neurointerventional procedures. This is particularly relevant in the increasingly “transradial first” culture of neurointerventional surgery. Moreover, some of these anomalies have a peculiar predilection for complications including aneurysm formation, dissection, and rupture during the procedure. Therefore, an understanding of these anomalies, their underlying embryological basis and associations, and pattern of circulation will help endovascular neurosurgeons and interventional radiologists navigate with confidence and consider relevant pathologic associations that may inform risk of cerebrovascular disease. Methods: Here, we present a brief review of the basic embryology of the common anomalies of the aortic arch along with their neurological significances and discuss, through illustrative cases, the association of aortic arch anomalies with cerebral vascular pathology. Conclusions: Understanding the aortic arch anomalies and its embryological basis is essential to safely navigate the cerebral vascular system during neurointerventional surgeries.

Original languageEnglish (US)
Pages (from-to)489-498
Number of pages10
JournalInterventional Neuroradiology
Issue number4
StatePublished - Aug 2022

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


  • Aortic arch
  • aberrant subclavian artery
  • aneurysm
  • coarctation of aorta
  • embryology
  • steal phenomenon
  • stroke
  • vertebral artery anomalies


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