Tortuosity of Target Carotid Artery Predicts Early Successful Revascularization and Functional Independence After Mechanical Thrombectomy

• Published in: Neurosurgery Vol. 67; no. Supplement_1
• Main Authors: Gomez-Paz, Santiago, Akamatsu, Yosuke, Mallick, Akashleena, Jordan, Noah J, Salem, Mohamed M, Thomas, Ajith J, Ogilvy, Christopher S, Moore, Justin M
• Format: Journal Article
• Language: English
• Published: Philadelphia Wolters Kluwer Health, Inc 01-12-2020
• Subjects: Neurosurgery; Stents; Surgical techniques
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyaa447_388

INTRODUCTION Extended procedural times in patients with acute ischemic stroke undergoing mechanical thrombectomy have been explored solely as a surrogate for difficult access. METHODS A retrospective review of 137 patients with emergent large vessel occlusion of the anterior circulation treated with mechanical thrombectomy at a large academic institution between 2015–2019 was performed. Cervical tortuosity seen in the diagnostic angiogram prior to a mechanical thrombectomy was assessed as the tortuosity index (T.I) of the target vessel on anteroposterior view. The T.I incorporates the ratio between the total distance of the cervical vessel proximal to the occluded artery and its straight distance [(actual/straight length-1) X 100]. RESULTS Median age [IQR] was 71 [61-80]; 79 (58%) females. Pre-procedural NIHSS score was 16 ± 6. Median T.I was 7.8 [3.6-14.4]. A total of 88 (64.2%) patients had a T.I < 10. Early revascularization (puncture to reperfusion time < 60 minutes) was accomplished in 93 (68%) patients. There was an absolute difference of 54.8% (95% CI, 2.74-13.13) in the rate of early revascularization in favor of a T.I < 10 (77.4% vs 22.6%). A multivariable analysis showed that a T.I < 10 (O.R 4.2; P = .004) and using a stent retriever with mechanical aspiration (O.R 9.4; P = .002) independently predicted early revascularization. A secondary analysis demonstrated that a T.I < 10 was an independent predictor of successful revascularization (TICI 2B/3) (O.R 2.3; CI 1.03-5.25; P = .041) and functional independence (most recent mRS 0–2) (O.R 3.4; CI 1.19-9.91; P = .023) CONCLUSION A tortuosity index < 10 is predictive of early successful revascularization and functional independence after mechanical thrombectomy of the anterior circulation.