BACKGROUND AND PURPOSE: Cervical internal carotid artery (ICA) tortuosity is thought to impede distal catheterization during attempted mechanical thrombectomy in patients with acute ischemic stroke. This study sought to assess the morphologic characteristics of ICAs and the effects of tortuosity on thrombectomy attempts. METHODS: A retrospective review was completed of neck CTAs of patients with acute ischemic stroke due to a large vessel occlusion that underwent attempted endovascular recanalization. Significant tortuosity of ICAs was defined as the presence of kink(s) (acute (<90°) angulation), loop(s) (C- or S-shaped curvature with 2+ areas of acute (<90°) angulation), or coil(s) (full 360° turn arterial bend). Findings were statistically compared to procedure time, successful recanalization rate, patient demographics, and co-morbidities. RESULTS: Of 120 included patients, 47 (39.2%) had some form of tortuosity of one or both ICAs. Twenty-eight patients (23.3%) had a kink of one or both ICAs; this was followed in frequency by loops (n = 20; 16.7%) and coils (n = 8; 6.7%). Kinks were associated with lower rates of successful recanalization (p = 0.02). The presence of any tortuosity (kinks, loops, or coils) was not associated with number of passes during thrombectomy (p = 0.88), successful recanalization (p = 0.11), or total procedure time (p = 0.22). No association was noted between the presence of tortuosity and age (p = 0.96) or prior or current tobacco use (p = 0.75 and p = 0.69, respectively). CONCLUSION: Among patients referred for urgent revascularization for large vessel occlusion, approximately 40% exhibit some tortuosity. Kinks may portend lower likelihood of recanalization success, although tortuosity as a whole seems to have little effect on endovascular thrombectomy.
BACKGROUND AND PURPOSE: Cervical internal carotid artery (ICA) tortuosity is thought to impede distal catheterization during attempted mechanical thrombectomy in patients with acute ischemic stroke. This study sought to assess the morphologic characteristics of ICAs and the effects of tortuosity on thrombectomy attempts. METHODS: A retrospective review was completed of neck CTAs of patients with acute ischemic stroke due to a large vessel occlusion that underwent attempted endovascular recanalization. Significant tortuosity of ICAs was defined as the presence of kink(s) (acute (<90°) angulation), loop(s) (C- or S-shaped curvature with 2+ areas of acute (<90°) angulation), or coil(s) (full 360° turn arterial bend). Findings were statistically compared to procedure time, successful recanalization rate, patient demographics, and co-morbidities. RESULTS: Of 120 included patients, 47 (39.2%) had some form of tortuosity of one or both ICAs. Twenty-eight patients (23.3%) had a kink of one or both ICAs; this was followed in frequency by loops (n = 20; 16.7%) and coils (n = 8; 6.7%). Kinks were associated with lower rates of successful recanalization (p = 0.02). The presence of any tortuosity (kinks, loops, or coils) was not associated with number of passes during thrombectomy (p = 0.88), successful recanalization (p = 0.11), or total procedure time (p = 0.22). No association was noted between the presence of tortuosity and age (p = 0.96) or prior or current tobacco use (p = 0.75 and p = 0.69, respectively). CONCLUSION: Among patients referred for urgent revascularization for large vessel occlusion, approximately 40% exhibit some tortuosity. Kinks may portend lower likelihood of recanalization success, although tortuosity as a whole seems to have little effect on endovascular thrombectomy.
Authors: Brian M Snelling; Samir Sur; Sumedh S Shah; Stephanie Chen; Simon A Menaker; David J McCarthy; Dileep R Yavagal; Eric C Peterson; Robert M Starke Journal: World Neurosurg Date: 2018-09-06 Impact factor: 2.104
Authors: Giulio Illuminati; Jean-Baptiste Ricco; Francesco G Caliò; Antonio D'Urso; Gianluca Ceccanei; Francesco Vietri Journal: Surgery Date: 2007-12-03 Impact factor: 3.982
Authors: Maiwand Sidiq; Emilia Scheidecker; Arne Potreck; Ulf Neuberger; Charlotte S Weyland; Sibu Mundiyanapurath; Martin Bendszus; Markus A Möhlenbruch; Fatih Seker Journal: Clin Neuroradiol Date: 2022-06-13 Impact factor: 3.649
Authors: Ghislaine Holswilder; Maaike Pme Stuart; Tine Dompeling; Nyika D Kruyt; Jelle J Goeman; Aad van der Lugt; Wouter J Schonewille; Geert J Lycklama À Nijeholt; Charles Blm Majoie; Lonneke Sf Yo; Frederick Ja Meijer; Henk A Marquering; Marieke Jh Wermer; Marianne Aa van Walderveen Journal: Eur Stroke J Date: 2022-02-08