Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
World Neurosurg. 2021 Aug;152:e1-e10. doi: 10.1016/j.wneu.2021.02.123. Epub 2021 Apr 20.
The literature is scarce for studies evaluating the anatomy of cervical vessels in patients with stroke. We sought to investigate the effect of vessel tortuosity in procedural, angiographic, and functional outcomes in patients with acute ischemic stroke treated with mechanical thrombectomy (MT).
Patients with an emergent large vessel occlusion of the anterior circulation treated with MT between 2015 and 2020 were included. The tortuosity of the internal carotid artery was recorded as the tortuosity index (TI) using the following formula: [(actual/straight length-1) × 100). A multivariable regression was performed to assess procedural, angiographic, and functional outcomes based on the TI.
A total of 212 patients were included. Median age was 72 years (interquartile range, 62-82 years); admission National Institutes of Health Stroke Scale score was 17 ± 6. Median TI was 7.9 (interquartile range, 3.7-19.7). A total of 127 patients (60%) had a TI <10. Early reperfusion (procedure time <60 minutes) was accomplished in 144 patients (67.9%). A multivariable analysis showed that patients with a TI <10 were more likely to achieve an early reperfusion (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.11-4.78; P = 0.025). A TI <10 was a predictor of successful reperfusion (OR, 2.0; CI, 1.05-3.93; P = 0.035) and an early reperfusion was the sole predictor of functional independence (most recent modified Rankin Scale score 0-2) (OR, 4.1; 95% CI, 1.62-10.53; adjusted P = 0.003).
Patients with a TI <10 are significantly more likely to achieve early successful reperfusion after MT for the treatment of acute ischemic stroke.
评估卒中患者颈血管解剖结构的文献很少。我们旨在研究血管迂曲对接受机械血栓切除术（MT）治疗的急性缺血性卒中患者的手术、血管造影和功能结局的影响。
纳入 2015 年至 2020 年间接受 MT 治疗的前循环大血管闭塞的紧急急性缺血性卒中患者。使用以下公式记录颈内动脉迂曲度：迂曲指数（TI）= [(实际/直线长度-1)×100]。进行多变量回归分析，根据 TI 评估手术、血管造影和功能结局。
共纳入 212 例患者。中位年龄为 72 岁（四分位距 62-82 岁）；入院时国立卫生研究院卒中量表评分 17±6。中位 TI 为 7.9（四分位距 3.7-19.7）。127 例患者（60%）TI＜10。144 例患者（67.9%）达到早期再灌注（＜60 分钟的手术时间）。多变量分析显示，TI＜10 的患者更有可能实现早期再灌注（优势比 [OR]，2.3；95%置信区间 [CI]，1.11-4.78；P=0.025）。TI＜10 是成功再灌注的预测因子（OR，2.0；95%CI，1.05-3.93；P=0.035），早期再灌注是功能独立（最近改良 Rankin 量表评分 0-2）的唯一预测因子（OR，4.1；95%CI，1.62-10.53；调整后 P=0.003）。
在接受 MT 治疗的急性缺血性卒中患者中，TI＜10 的患者更有可能实现早期成功再灌注。
