Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2025
Impact of arterial tortuosity on endovascular thrombectomy outcomes in acute anterior circulation ischemic stroke.
СтатьяНазвание и аннотация: Перевод в очереди
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Liu Qian, Chen Li-Zhang, Jiang Xin, Zheng Hong-Bo, He Li
Аннотация
BACKGROUND: Arterial tortuosity presents a common technical challenge in endovascular thrombectomy (EVT), yet its impact on procedural and clinical outcomes remains incompletely understood. This study aimed to evaluate the effect of anterior circulation tortuosity on EVT efficacy and safety.
METHODS: This retrospective study analyzed data from consecutive patients who underwent EVT for anterior circulation large vessel occlusion (July 2015-July 2022). Tortuosity was assessed in the cervical (C1) and cavernous (C4) segments of the internal carotid artery (ICA) and the sphenoidal (M1) segment of the middle cerebral artery (MCA). Clinical and procedural outcomes were compared between patients with and without tortuosity. Mediation analysis was conducted to explore causal pathways.
RESULTS: Among 440 patients, 26.14 % had ICA (C1/C4) tortuosity and 14.55 % had M1 tortuosity. ICA tortuosity was associated with higher risks of total intracranial hemorrhage (ICH) (aOR 2.092, 95 % CI 1.225-3.092), symptomatic ICH (aOR 2.083, 95 % CI 1.049-4.134), prolonged procedure duration (>60 min, aOR 1.973, 95 % CI 1.101-3.534). Mediation analysis revealed that procedure duration explained 9.7 % of the association between ICA tortuosity and total ICH, and 16.9 % of its association with symptomatic ICH. Furthermore, the number of stent retriever attempts accounted for 14.1 % of the total effect on total ICH and appeared to fully mediate the relationship between ICA tortuosity and symptomatic ICH, though wide confidence intervals suggest cautious interpretation. These findings indicate that procedural complexity may serve as a key pathway linking tortuosity to hemorrhagic complications.
CONCLUSION: ICA tortuosity is associated with increased procedural difficulty and heightened risk of hemorrhage following EVT. The observed mediation effects underscore the importance of recognizing tortuous anatomy during preprocedural planning and may inform tailored device selection and procedural strategies to improve EVT safety and efficacy.
METHODS: This retrospective study analyzed data from consecutive patients who underwent EVT for anterior circulation large vessel occlusion (July 2015-July 2022). Tortuosity was assessed in the cervical (C1) and cavernous (C4) segments of the internal carotid artery (ICA) and the sphenoidal (M1) segment of the middle cerebral artery (MCA). Clinical and procedural outcomes were compared between patients with and without tortuosity. Mediation analysis was conducted to explore causal pathways.
RESULTS: Among 440 patients, 26.14 % had ICA (C1/C4) tortuosity and 14.55 % had M1 tortuosity. ICA tortuosity was associated with higher risks of total intracranial hemorrhage (ICH) (aOR 2.092, 95 % CI 1.225-3.092), symptomatic ICH (aOR 2.083, 95 % CI 1.049-4.134), prolonged procedure duration (>60 min, aOR 1.973, 95 % CI 1.101-3.534). Mediation analysis revealed that procedure duration explained 9.7 % of the association between ICA tortuosity and total ICH, and 16.9 % of its association with symptomatic ICH. Furthermore, the number of stent retriever attempts accounted for 14.1 % of the total effect on total ICH and appeared to fully mediate the relationship between ICA tortuosity and symptomatic ICH, though wide confidence intervals suggest cautious interpretation. These findings indicate that procedural complexity may serve as a key pathway linking tortuosity to hemorrhagic complications.
CONCLUSION: ICA tortuosity is associated with increased procedural difficulty and heightened risk of hemorrhage following EVT. The observed mediation effects underscore the importance of recognizing tortuous anatomy during preprocedural planning and may inform tailored device selection and procedural strategies to improve EVT safety and efficacy.