Arterial Tortuosity Is a Potent Determinant of Safety in Endovascular Therapy for Acute Ischemic Stroke

Author:

Saber Hamidreza1,Colby Geoffrey P.2,Mueller‐Kronast Nils3,Aziz‐Sultan Mohammad Ali4,Klucznik Richard5,Saver Jeffrey L.6,Sanossian Nerses7,Hellinger Frank R.8,Yavagal Dileep R.9,Yao Tom L.10,Jahan Reza2,Haussen Diogo C.11,Nogueira Raul G.12,Froehler Michael T.13,Zaidat Osama O.14,Liebeskind David S.6ORCID,

Affiliation:

1. Departments of Neurology and NeurosurgeryDell Medical School, University of Texas at AustinAustin TX

2. Departments of Radiology and NeurosurgeryUCLALos Angeles CA

3. Delray Medical Center/Tenet South FloridaDelray Beach FL

4. Brigham and Women's HospitalBoston MA

5. Methodist HospitalHouston TX

6. Department of NeurologyUCLALos Angeles CA

7. University of South CaliforniaLos Angeles CA

8. Florida HospitalOrlando FL

9. University of Miami/Jackson Memorial HospitalMiami FL

10. Norton Neuroscience InstituteLouisville KY

11. Emory University School of Medicine/Grady Memorial HospitalAtlanta GA

12. University of Pittsburgh Medical CenterPittsburgh PA

13. Vanderbilt University, Medical CenterNashville TN

14. Mercy St. Vincent HospitalToledo OH

Abstract

Background Subarachnoid hemorrhage (SAH) associated with vessel injury during endovascular therapy for acute ischemic stroke is a known complication. Arterial anatomy may predispose to increased risk of SAH and technical safety, yet factors such as clot location, arterial size, and tortuosity have not been explored. We examined these anatomic factors with respect to SAH during thrombectomy. Methods Arterial anatomy at the site of occlusion and mechanical thrombectomy during device deployment was detailed by the STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) core laboratory. Luminal diameters, arterial branching, and segmental tortuosity were measured. Arterial tortuosity was quantified using the distance factor metric. Statistical analyses included descriptive variables of arterial anatomy, with univariable and multivariable modeling to predict SAH. Results Arterial tortuosity in each segment from the proximal cerebral arteries to the site of occlusion was quantified in 790 subjects treated with mechanical thrombectomy in STRATIS. Cumulative arterial tortuosity to the site of vessel occlusion was greater in distal lesions. SAH was clearly linked with more distal thrombectomy ( = 0.02), occurring in 19.0% of distal M2, 16.7% of M3, 7.3% of distal M1, 5.8% of proximal M2, 2.4% of distal internal carotid artery, and 2.1% of proximal M1. In multivariable analysis after adjusting for arterial diameter at the site of occlusion, arterial tortuosity was a significant predictor of SAH (upper tertile versus 1: odds ratio, 3.08 [95% CI, 1.04–9.09]; = 0.04), while arterial diameter was unrelated to SAH ( = 0.30) when accounting for tortuosity. Conclusion This novel analysis of arterial tortuosity and angiographic anatomy during mechanical thrombectomy establishes tortuosity as a determinant of SAH, providing insight for future techniques and innovative device designs.

Publisher

Ovid Technologies (Wolters Kluwer Health)

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3