Correlation of Extracranial Internal Carotid Artery Tortuosity Index and Intraprocedural Complications during Carotid Artery Stenting

Abstract

Background: To investigate the correlation between tortuosity of extracranial internal carotid artery (EICA) and intraprocedural complications in patients undergoing carotid artery stenting (CAS). Methods: The study included 244 EICA in 223 patients undergoing CAS. Tortuosity in EICA was measured by the tortuosity index (TI). Multivariate logistic regression was performed to assess the independent risk factors of vasospasm during CAS. Receiver operating characteristic curve was performed to identify the cut-off of TI to predict vasospasm. Results: During the 244 CAS, 71 EICA presented vasospasm and 114 CAS presented hypotension. High TI, long procedural duration and female are independent risk factors for vasospasm during CAS. TI of 118 was the optimal cut-off to predict vasospasm during CAS (sensitivity: 85.9%, specificity: 78.6%). Linear regression analysis demonstrated that TI is positively correlated with procedural duration (p < 0.001). There was no significant difference in TI between the hypotension and non-hypotension groups (p = 0.145). Conclusion: TI is an independent risk factor for vasospasm during CAS and a TI ≥118 has the high sensitivity and specificity to predict vasospasm. Our results indicate the value of assessing tortuosity of EICA prior to choosing or performing the procedure in patients with carotid stenosis or occlusion.

Angiographic Structural Differentiation between Native Arteriogenesis and Therapeutic Synangiosis in Intracranial Arterial Steno-Occlusive Disease

“…These differences were detected by analyzing three different aspects of the morphology of the collaterals: the branching pattern, tortuosity, and fractal connectivity. While, these have been previously established in the description of vascular morphology in the systemic circulation, 9,10,27,28 this is the first study to utilize all three indices in tandem to differentiate and characterize cerebrovasculature. Branching angioscore has previously been used as a marker for angiogenesis.…”

“…9 Tortuosity index has proven to be useful in analyzing coronary arteries to differentiate patients with chronic pressure and volume overload as well as a marker of adverse outcomes in connective tissue disorders. 10,27,28 Local connected fractal dimensions have been used previously to compare differences in retinal vasculature and differentiate oral epithelium according to degree of malignancy. 29,30 …”

Predictors of periprocedural complications of carotid artery stenting - a multivariate analysis of a single-centre experience

“…This leads to a higher risk of triggering embolic debris, thrombus, and dissection. In previous reports, TI was an objective method of measurement of tortuosity in carotid arteries increases the risk of neurologic complications [14,24]. A study by Faggioli et al also demonstrated that proximal TI was signifi cantly associated with both technical success and neurologic complications after CAS [14].…”

Comparison of closed-cell and hybrid-cell stent designs in carotid artery stenting: clinical and procedural outcomes

“…The free cell area is small and vessel wall support is better with closed-cell stents, causing endothelial irritation throughout the full stent length compared to hybrid-cell stents with an open-cell segment in the proximal and distal part of the stent with low radial force. A high tortuosity index, long procedural duration and female gender are independent risk factors for vasospasm during CAS [ 16 ]. However, in the current study, there was no difference in these factors between the groups.…”