Aortic arch types and arch anomalies in patients undergoing carotid endarterectomy: a retrospective single-center analysis and comparison with population prevalences

Aortic arch anatomy affects the feasibility and safety of endovascular carotid interventions. Data on the distribution of aortic arch types and branching anomalies in patients undergoing carotid endarterectomy (CEA), particularly from the Eastern Mediterranean region, remain limited. This study aimed to determine the prevalence of aortic arch types (I-III) and arch anomalies in a CEA cohort and compare these findings with population prevalences. A retrospective, single-center, observational study was conducted on 532 consecutive patients who underwent unilateral CEA due to carotid stenosis at Hatay Mustafa Kemal University Hospital between January 2020 and December 2025. Preoperative computed tomography angiography images were reviewed to classify arch type and identify branching anomalies. Descriptive statistics were calculated with Wilson 95% confidence intervals. Observed prevalence rates were compared with published reference values using one-sample proportion tests and chi-square goodness-of-fit analysis. Associations between arch type and clinical variables were evaluated using chi-square and Kruskal-Wallis tests. Logistic regression identified independent predictors of arch anomalies. The cohort (mean age 70.6 ± 8.6 years; 66.9% male; 57.9% symptomatic) showed the following arch type distribution: Type I 49.4%, Type II 34.6%, and Type III 16.0%. Half of the patients (50.6%) had complex arch anatomy (Type II–III). The overall distribution differed from that reported by Zhang et al. (χ² = 44.3, p < 0.001), with fewer Type III aortic arches. Aortic arch anomalies were identified in 19.7%: bovine arch in 16.2%, left vertebral artery arising from the arch in 2.8%, aberrant right subclavian artery in 1.1%, and right aortic arch in 0.2%. No demographic or clinical variable independently predicted anomaly presence (all p > 0.2). These disparities likely reflect ethnic anatomical variation between Eastern Mediterranean and East Asian populations. In this Eastern Mediterranean CEA cohort, Type III arch was less frequent than in previously reported series, and arch anomalies were present in approximately one-fifth of patients. The arch type distribution was independent of clinical risk factors, supporting the view that arch anatomy reflects intrinsic variation rather than atherosclerotic burden. These findings may help inform pre-procedural planning when endovascular alternatives to CEA are considered.