Abstract WP163: Relationship Between Three-dimensional Arterial Tortuosity And Difficulty Of Guide Catheter Access During Endovascular Reperfusion Therapy

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Introduction: Few studies have investigated the tortuosity of great vessels only in the longitudinal direction during endovascular reperfusion therapy. This study evaluated the tortuosity of the great vessels in the perpendicular and longitudinal directions by using novel reference line and how it affects procedural difficulty. Methods: We retrospectively reviewed the medical records of 294 patients with large vessel occlusion. Features of the anatomy of the ipsilateral great vessels were investigated by preintervention CT angiography. The reference line used to evaluate tortuosity was defined as a line from the origin of each ipsilateral great vessel to the entrance of the external auditory canal (AE-line). Coronal and sagittal angles were calculated using the AE-line and the most curved point of each ipsilateral great vessel. The right side of the reference line was negative and the left side was positive, and similarly, the ventral side of the reference line was negative and the dorsal side of the reference line was positive. Patients were divided into three groups with a threshold of -20° and 20° based on sagittal and coronal angles on the both sides, and finally into nine groups. (Figure) Reference group was set to Group 5. Procedural difficulty was determined by whether or not the internal carotid artery could be accessed within 10 min. Results: On the left side, compared with the reference group, the odds ratio [OR] (95% confidence interval [CI]) for the procedural difficulty in the Group 9 was 9.020 (2.85-28.5; p<0.001). On the right side, the ORs (95% CI) for the procedural difficulty in the Group 2, Group 3, and Group 9 were 21.700 (2.200-215.000; p=0.008), 29.000 (1.770-475.000; p=0.018), and 65.200 (8.010-532.000; p<0.001), respectively. Conclusion: There was a strong correlation between difficulty in guide catheter placement in the internal carotid artery and three-dimensional tortuosity when using the AE-line as a reference.