Impact of carotid tortuosity on outcome after endovascular thrombectomy
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ORIGINAL ARTICLE
Impact of carotid tortuosity on outcome after endovascular thrombectomy Ronen R. Leker 1 & Scott E. Kasner 2 & Hosnei Abu El Hasan 3 & Tzvika Sacagiu 1 & Asaf Honig 1 & John M. Gomori 4 & Shaobo Guan 2 & Omar Choudhry 5 & Robert W. Hurst 5 & David Kung 6 & Brian Pukenas 5 & Neda Sedora-Roman 5 & Preethi Ramchand 5 & Jose E. Cohen 3 Received: 7 July 2020 / Accepted: 7 October 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract 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. Keywords Cerebrovascular disease . Endovascular . Stroke . Thrombectomy
Introduction Ronen R. Leker and Scott E. Kasner contributed equally to this work. * Ronen R. Leker [email protected] 1
Department of Neurology, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120 Jerusalem, Israel
2
Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
3
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
4
Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
5
Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
6
Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
Endovascular thrombectomy (EVT) including stentrieverbased thrombectomy and thrombus aspiration have become the mainstay of therapy for patients with large vessel occlusion (LVO) stroke [1]. The success of these procedures depends on various pathophysiological processes including collateral status [2–4], clot composition and location [5–9], and previous brain injury among others [10]. Procedure-related markers such as
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