Department of Neurology, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel.
Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
Neurol Sci. 2021 Jun;42(6):2347-2351. doi: 10.1007/s10072-020-04813-8. Epub 2020 Oct 12.
Endovascular thrombectomy (EVT) is efficacious in patients with large vessel occlusion stroke (LVO). We explored whether internal carotid (ICA) tortuosity increases the technical difficulty of EVT thereby lowering the chances of successful recanalization and favorable outcomes.
Consecutive patients with LVO and patent ICAs who underwent EVT were included. Carotid tortuosity was determined on pre-EVT CTA and classified by raters blinded to outcomes into: type 1-straight ICA trunk and type 2-severe tortuosity potentially impeding adequate catheter placement. Thrombolysis in cerebral infarction (TICI) 2b-3 was considered successful recanalization, and 90-day-modified Rankin Scale ≤ 2 was considered favorable functional outcome.
Among 302 patients (mean age 70 ± 15, median NIHSS 17), 53% had type 1, and 47% type 2 tortuosity. Overall, 85% had successful recanalization. Patients with type 2 tortuosity were significantly older (p < 0.0001) and less frequently achieved successful recanalization (80% vs. 90%; p = 0.019) but had similar outcomes compared with those without tortuosity. On regression analysis, marked tortuosity was associated with lower chances of successful recanalization (OR 0.43 95% CI 0.20-0.92) but had no effect on clinical outcomes.
Carotid tortuosity does not appear to impact the likelihood of favorable functional outcome but may influence recanalization.
血管内血栓切除术（EVT）对大血管闭塞性脑卒中（LVO）患者有效。我们探讨颈内动脉（ICA）迂曲是否会增加 EVT 的技术难度，从而降低成功再通和获得良好结局的机会。
连续纳入 LVO 且 ICA 通畅的接受 EVT 的患者。在 EVT 前 CTA 上评估颈动脉迂曲程度，由对结局不知情的评估者将其分为：1 型-ICA 干直，2 型-严重迂曲可能妨碍充分置管。脑梗死溶栓（TICI）2b-3 被认为是成功再通，90 天改良 Rankin 量表≤2 被认为是良好的功能结局。
302 例患者（平均年龄 70±15 岁，中位数 NIHSS 17）中，53%为 1 型，47%为 2 型迂曲。总体上，85%实现了成功再通。2 型迂曲患者年龄显著更大（p<0.0001），成功再通率显著更低（80%比 90%；p=0.019），但与无迂曲患者的结局相似。回归分析显示，显著迂曲与成功再通的可能性降低相关（OR 0.43，95%CI 0.20-0.92），但对临床结局无影响。
颈动脉迂曲似乎不会影响良好功能结局的可能性，但可能会影响再通。
