Farooq Jeffrey, Lee Jea Young
Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
Brain Circ. 2021 Mar 30;7(1):3-7. doi: 10.4103/bc.bc_5_21. eCollection 2021 Jan-Mar.
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.
血管内机械取栓术能有效清除动脉管腔内的闭塞性血栓；然而，几乎没有文献支持血管几何形状与手术结果的相关性。包括血管角度和迂曲程度在内的关键血管特征会影响将支架取栓装置推进至闭塞部位的能力。因此，评估颈动脉导管通路可达性对急性缺血性卒中（AIS）患者取栓结果的影响至关重要。传统成像方式无法完整呈现血管迂曲情况，且容易出现临床判断错误。最近的三维计算机断层血管造影图像分析技术克服了这些局限性，能够准确计算迂曲度和角度测量值。这些新颖的图像有助于将常见解剖变异患者分类为可用专门设计的导管装置进行治疗的组。重要的是，这种图像分析方法揭示了颈总动脉和颅外颈内动脉存在显著角度，这与到达闭塞部位的延迟相关。与中风风险增加相关的年龄增长也会增加严重迂曲的发生率。半自动测量技术还表明，近3%的导管通路存在完整的360°动脉环，且双侧的总体角度不同。在本综述中，我们研究了这种新颖图像分析程序的实用性，并评估了近期与AIS患者神经血管内取栓术相关的文献。我们在三个文献数据库——PubMed、Embase和Web of Science中查询了调查临床前和临床取栓应用的原始文章。
