Aortic and supra-aortic arterial tortuosity and access technique: Impact on time to device deployment in stroke thrombectomy

Abstract

Background Longer intervals to reperfusion in patients treated with mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) stroke are associated with worse outcomes and influenced by the operator’s ability to navigate individual anatomy. Our aims were to assess the impact of time from puncture to first deployment of the MT device (DT) on technical and clinical outcomes, develop an Anatomical A ssessment for Mechanical Thrombectomy Score (ASMETS) that could predict DT and assess how different methods of intracranial access (coaxial-direct or exchange) influence this. Methods Retrospective review of a prospective database of patients treated with MT for ELVO between November 2015 and August 2018. CTAs were assessed for ASMETS. Intracranial access technique was at the discretion of the operator. Technical and clinical outcomes and complications were recorded. Linear and logistic regression analysis was performed. Results 92 patients were included. The impact of DT on clinical outcomes was significant. An unfavourable ASMET score is significantly associated with longer DT (p = 0.002) and linear regression showed DT time can be predicted by ASMETS – F(1,90) = 6.182, p = 0.015. No difference was demonstrated between different access techniques. Conclusion CTA-based ASMETS can predict time between arterial puncture and deployment of the mechanical thrombectomy device in stroke patients, irrespective of the technique used to catheterise the target ICA. This could inform the operator in preparing appropriate strategies to overcome challenging vascular anatomy in patients undergoing MT.

Deep Learning-based Assessment of Internal Carotid Artery Anatomy to Predict Difficult Intracranial Access in Endovascular Recanalization of Acute Ischemic Stroke

“…and Mokin et al. [ 12 , 13 , 17 ]; however, when testing with the predictions of the trained CNN, no statistical significance between the groups was detected. This might be due to the limited number of cases, as only the cases from the test set could be used to assess the network’s predictions.…”

“…Existing work has already proposed scores to grade extracranial vasculature for difficulty regarding EVT, namely the B.A.D. [ 12 ] and ASMETS [ 13 ] scores. These scores rely on the aortic arch, CCA, and ICA morphology.…”

Age and duration of hypertension are associated with carotid artery tortuosity

“…In addition, carotid artery tortuosity has more practical significance for neurointerventional doctors. When intravascular interventional therapy encounters a kinked or coiled artery, the treatment difficulty, radiation exposure time, complications, and even surgical failure rate increase significantly ( 14 , 15 ). Moreover, during mechanical thrombectomy in acute cerebral infarction, patients with carotid artery tortuosity require a higher surgical time and have a worse prognosis ( 15 , 16 ).…”

“…When intravascular interventional therapy encounters a kinked or coiled artery, the treatment difficulty, radiation exposure time, complications, and even surgical failure rate increase significantly ( 14 , 15 ). Moreover, during mechanical thrombectomy in acute cerebral infarction, patients with carotid artery tortuosity require a higher surgical time and have a worse prognosis ( 15 , 16 ). Therefore, with the development of cerebrovascular interventional therapy, people have to pay attention to this phenomenon.…”

A Fully Automatic Method for Vascular Tortuosity Feature Extraction in the Supra-Aortic Region: Unraveling Possibilities in Stroke Treatment Planning

“…These studies have in common that the measurement of tortuosityrelated features is at best semi-automatic (Mokin et al, 2020), while some rely on completely manual processes (Kaymaz et al, 2017;Benson et al, 2020;Schwaiger et al, 2015;Snelling et al, 2018;Rosa et al, 2021). This makes them unsuitable as acute decision-making tools in the selection of the ideal access site.…”