Abstract
Background: Endovascular thrombectomy (EVT) is effective in patients with large vessel occlusion (LVO) stroke. We hypothesized that a tortuous internal carotid (ICA) may increase the technical difficulty of EVT and prevent optimal positioning of aspiration catheters thereby lowering the chances of successful recanalization and likelihood of favorable outcome. Patients and Methods: Consecutive patients with LVO and patent cervical ICAs who underwent EVT at 2 academic centers were included. Demographics, clinical and radiological factors, time metrics, occurrence of symptomatic intracranial hemorrhage (sICH), functional outcome and survival data were collected. ICA tortuosity was determined on pre-EVT sagittal maximal intensity projection images and classified into three categories: type 1 - straight ICA trunk, type 2 - moderate degree of tortuosity not judged to impair distal catheter placement and type 3 - severe tortuosity preventing optimal aspiration catheter placement. Thrombolysis in cerebral infarction (TICI) 2b-3 was considered successful recanalization and modified Rankin Scale (mRS)≤2 90days post stroke was considered favorable outcome. Results: The study included 313 patients (mean age 69±15, median NIHSS 17), and 53% had type 1, 33% type 2 and 14% type 3 ICA tortuosity. Severe tortuosity was significantly less common in patients with atrial fibrillation (p=0.032) but no other factors were associated with the degree of tortuosity. Overall, 85% had successful recanalization and 47% had favorable outcomes. The chances of favorable outcome at 90days were independent of the degree of observed tortuosity (53% type1, 32% type2 and 49% type3 respectively, p=0.94). Similarly, mortality rates, chances of succesful recanalization and sICH rates did not differ between the tortuosity groups. Clustering patients with moderate and severe tortuosity into one group showed that those with marked tortuosity were significantly older (74±12 vs. 65±16; p<0.0001) and less frequently achieved successful recanalization (79% vs. 89%; p=0.018) but had similar functional outcomes and survival rates compared to those with mild tortuosity. Conclusions: Carotid tortuosity does not impact functional outcome but may influence recanalization rates.
Published Version
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