Background and objectives

Endovascular thrombectomy (EVT) is efficacious in patients with large vessel occlusion stroke (LVO). We explored whether internal carotid (ICA) tortuosity increases the technical difficulty of EVT thereby lowering the chances of successful recanalization and favorable outcomes.

Patients and methods

Consecutive patients with LVO and patent ICAs who underwent EVT were included. Carotid tortuosity was determined on pre-EVT CTA and classified by raters blinded to outcomes into: type 1—straight ICA trunk and type 2—severe tortuosity potentially impeding adequate catheter placement. Thrombolysis in cerebral infarction (TICI) 2b-3 was considered successful recanalization, and 90-day-modified Rankin Scale ≤ 2 was considered favorable functional outcome.

Results

Among 302 patients (mean age 70 ± 15, median NIHSS 17), 53% had type 1, and 47% type 2 tortuosity. Overall, 85% had successful recanalization. Patients with type 2 tortuosity were significantly older (p < 0.0001) and less frequently achieved successful recanalization (80% vs. 90%; p = 0.019) but had similar outcomes compared with those without tortuosity. On regression analysis, marked tortuosity was associated with lower chances of successful recanalization (OR 0.43 95% CI 0.20–0.92) but had no effect on clinical outcomes.

Conclusions

Carotid tortuosity does not appear to impact the likelihood of favorable functional outcome but may influence recanalization.

中文翻译：

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颈内曲折度对血管内血栓切除术后预后的影响

背景和目标

血管内血栓切除术（EVT）对大血管阻塞性中风（LVO）的患者有效。我们探讨了颈内动脉（ICA）的曲折度是否增加了EVT的技术难度，从而降低了成功进行再通和良好结局的机会。

患者和方法

包括接受过EVT的LVO和ICA专利的连续患者。颈动脉曲折度是在EVT之前的CTA上确定的，并由不了解结果的评估者分类为：1型–直ICA躯干和2型–严重曲折可能会妨碍导管的适当放置。脑梗死（TICI）2b-3中的溶栓被认为是成功的再通，经90天修订的Rankin Scale≤2被认为是有利的功能预后。

结果

在302名患者中（平均年龄70±15，中位NIHSS 17），53％患有1型和47％患有2型to曲。总体而言，有85％的患者成功进行了再通。2型曲折患者明显年龄较大（p  <0.0001），成功再通的频率较低（80％比90％；p  = 0.019），但与无曲折患者相比，结果相似。在回归分析中，明显的曲折性与再通成功的机会较低（OR 0.43 95％CI 0.20–0.92），但对临床结局没有影响。

结论

颈动脉曲折似乎并不影响功能预后的可能性，但可能影响再通。