Semi-automated measurement of vascular tortuosity and its implications for mechanical thrombectomy performance

Mokin, Maxim; Waqas, Muhammad; Chin, Felix; Rai, H; Senko, Jillian; Sparks, Adam; Ducharme, Richard; Springer, Michael; Borlongan, Cesario V.; Levy, Elad I.; Ionita, Ciprian N.; Siddiqui, Adnan H.

doi:10.1007/s00234-020-02525-6

Cited by 26 publications

(30 citation statements)

References 18 publications

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“…So far, preliminary work showed that a semi-automated method can be used to quantify tortuosity of the aortic arch and supra-aortic arteries on CTA. 30 This technique could be useful for the identification of patients with difficult vascular anatomy but needs further development. In addition, the associations between vascular characteristics and procedural outcomes may be different for patients treated via a transradial approach.…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of extracranial vascular characteristics on procedural duration and revascularization success in endovascularly treated acute ischemic stroke patients

Holswilder

Stuart

Dompeling

et al. 2022

European Stroke Journal

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Introduction Vascular anatomy might affect endovascular treatment success in acute ischemic stroke patients with large vessel occlusion. We investigated the prognostic value of extracranial vascular characteristics on procedural time and revascularization success in patients with large vessel occlusion in the anterior cerebral circulation. Patients and methods We included 828 patients endovascularly treated within 6.5 hours of symptom onset from the Dutch MR CLEAN-Registry. We evaluated aortic arch configuration, stenosis and tortuosity of supra-aortic arteries, and internal carotid arteries (ICAs) on pre-intervention CTA. We constructed logistic prediction models for outcome variables procedural duration (≥60 minutes) and non-successful revascularization (extended thrombolysis in cerebral infarction (eTICI) of 0–2A) using baseline characteristics and assessed the effect of extracranial vascular characteristics on model performance. Results Cervical ICA tortuosity and stenosis ≥99% improved prediction of long procedural duration compared with baseline characteristics from area under the curve of 0.61 (95% CI: 0.57–0.65) to 0.66 (95% CI: 0.62–0.70) ( P < 0.001). Cervical ICA tortuosity was significantly associated with non-successful recanalization. Prediction of non-successful revascularization did not improve after including aortic arch elongation, acute take-off angle, aortic variant, origin stenosis of supra-aortic arteries, and cervical ICA tortuosity, with an area under the curve of 0.63 (95% CI: 0.59–0.67) compared with 0.59 (95% CI: 0.55–0.63) ( P = 0.11). Conclusion Extracranial vascular characteristics have additional prognostic value for procedural duration, but not for revascularization success, compared with baseline characteristics. Performance of both prediction models is limited in patients treated for large vessel occlusion.

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Section: Discussionmentioning

confidence: 99%

The prognostic value of extracranial vascular characteristics on procedural duration and revascularization success in endovascularly treated acute ischemic stroke patients

Holswilder

Stuart

Dompeling

et al. 2022

European Stroke Journal

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“…[ 12 ] In each instance of failed access, both the common carotid artery (CCA) and extracranial internal carotid artery (ICA) exhibited tremendous tortuosity, with a full 360° loop in one case. [ 12 ] However, delays result in protracted neuroendovascular interventions, which increase the intracranial hemorrhage rate and reduce postoperative functional independence. [ 13 14 15 ]…”

Section: Timing Of Endovascular Mechanical Thrombectomymentioning

confidence: 99%

“…Detailed analysis of the carotid artery in these CTA images reveals increases in CCA-brachiocephalic segment tortuosity lengthen access time. [ 12 ] It also demonstrates that differences in the vertex to jugular notch height, type two and three aortic arch, and bovine arch, do not extend access times. [ 12 ]…”

Section: Novel Measurements Of Tortuositymentioning

confidence: 99%

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Vascular tortuosity in endovascular mechanical thrombectomy

Farooq

Lee

2021

Brain Circulation

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Endovascular mechanical thrombectomy effectively removes occlusive thrombi from the arterial lumen; however, there is little literature supporting the relevance of vascular geometry on surgical outcomes. Critical vessel characteristics including the degree of angulation and tortuosity influence the ability to advance stent retriever devices toward the site of occlusion. Therefore, it is crucial to evaluate the impact of carotid artery catheter pathway accessibility on the thrombectomy outcomes in acute ischemic stroke (AIS) patients. Traditional imaging modalities generate incomplete pictures of the vascular tortuosity and are prone to clinical judgment errors. Recent three-dimensional computed tomography angiography image analysis techniques circumvent these limitations to calculate accurate tortuosity and angulation measurements. These novel images facilitate classifying common anatomical variant patients into groups that may be treated with specially designed catheter devices. Importantly, this image analysis method reveals significant angulation in the common carotid artery and extracranial internal carotid artery that correlates with delays in reaching the occlusion site. Increased age, which is associated with increased risk of stroke, also increases the incidence of severe tortuosity. The semi-automated measurements technique also demonstrate that full 360° arterial loops are present in nearly 3% of catheter pathways and that the overall degree of angulation differs bilaterally. In this review, we examine the utility of this novel image analysis procedure and evaluate the recent literature relevant to neuroendovascular thrombectomy in AIS patients. Three literature databases – PubMed, Embase, and Web of Science were queried for original articles investigating both preclinical and clinical thrombectomy applications.

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“…Although the way the ICA geometry affects the hemodynamics and different pathologies onset (aneurysms and stenosis) has been already investigated (6)(7)(8)(9)(10), the correlation between the ICA geometry and thrombectomy procedure outcome remains under-studied. Mokin et al analyzed the correlation between the ICA geometric parameters and the outcome of the thrombectomy procedure, finding that the intracranial tortuosity did not influence the needed number of passes with thrombectomy devices (11). Srivatsa et al investigated the influence of vessel morphology on the fist-pass success of mechanical thrombectomy in patients with MCA occlusions (12).…”

Section: Introductionmentioning

confidence: 99%

Impact of the Internal Carotid Artery Morphology on in silico Stent-Retriever Thrombectomy Outcome

Bridio

Luraghi

Matas

et al. 2021

Front. Med. Technol.

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The aim of this work is to propose a methodology for identifying relationships between morphological features of the cerebral vasculature and the outcome of in silico simulations of thrombectomy, the mechanical treatment for acute ischemic stroke. Fourteen patient-specific cerebral vasculature segmentations were collected and used for geometric characterization of the intracranial arteries mostly affected by large vessel occlusions, i.e., internal carotid artery (ICA), middle cerebral artery (MCA) and anterior cerebral artery (ACA). First, a set of global parameters was created, including the geometrical information commonly provided in the clinical context, namely the total length, the average diameter and the tortuosity (length over head-tail distance) of the intracranial ICA. Then, a more exhaustive geometrical analysis was performed to collect a set of local parameters. A total of 27 parameters was measured from each patient-specific vascular configuration. Fourteen virtual thrombectomy simulations were performed with a blood clot with the same length and composition placed in the middle of the MCA. The model of TREVO ProVue stent-retriever was used for all the simulations. Results from simulations produced five unsuccessful outcomes, i.e., the clot was not removed from the vessels. The geometric parameters of the successful and unsuccessful simulations were compared to find relations between the vascular geometry and the outcome. None of the global parameters alone or combined proved able to discriminate between positive and negative outcome, while a combination of local parameters allowed to correctly identify the successful from the unsuccessful simulations. Although these results are limited by the number of patients considered, this study indicates a promising methodology to relate patient-specific geometry to virtual thrombectomy outcome, which might eventually guide decision making in the treatment of acute ischemic stroke.

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Semi-automated measurement of vascular tortuosity and its implications for mechanical thrombectomy performance

Cited by 26 publications

References 18 publications

The prognostic value of extracranial vascular characteristics on procedural duration and revascularization success in endovascularly treated acute ischemic stroke patients

The prognostic value of extracranial vascular characteristics on procedural duration and revascularization success in endovascularly treated acute ischemic stroke patients

Vascular tortuosity in endovascular mechanical thrombectomy

Impact of the Internal Carotid Artery Morphology on in silico Stent-Retriever Thrombectomy Outcome

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