Department of Neuroendovascular Therapy, St Luke's International Hospital, Chuo-ku, Tokyo, Japan.
Department of Neurology, Tokyo Women's Medical University, Tokyo, Shinjuku-ku, Tokyo, Japan.
Interv Neuroradiol. 2024 Apr;30(2):154-162. doi: 10.1177/15910199221104922. Epub 2022 Jun 3.
We aimed to quantify the tortuosity of the middle cerebral artery (MCA) and assess its effects on radiological and clinical outcomes in patients with acute MCA occlusions who received mechanical thrombectomy (MT).
This retrospective study enrolled 53 patients with acute ischemic stroke due to MCA M1 or M2 segment occlusion who underwent MT using stent retrievers (SRs). Tortuosity index (TI) was defined to quantify the tortuosity of the MCA M1 segment using the following formula: (actual distance / straight distance) × 100. For each patient, four TIs were measured in the anteroposterior and caudal views for both ipsilateral and contralateral sides to the occluded site (TI-APi, TI-APc, TI-CAUi, and TI-CAUc, respectively) using magnetic resonance angiography (MRA) or computed tomography angiography (CTA). We defined the first-pass effect (FPE) as first-pass mTICI classification ≥2b reperfusion.
Patients who did not achieve FPE had significantly higher TI-APi (112 vs. 106; = 0.004), TI-APc (111 vs. 105; = 0.005), TI-CAUi (110 vs. 105; = 0.002), and TI-CAUc (110 vs. 105; = 0.001) than those who achieved FPE. In multivariable analysis, higher TI-APi, TI-CAUi, and TI-APc were independently associated with an increased rate of unsuccessful FPE (odds ratio (OR) [95% confidence interval (CI)]: 1.25 [1.02-1.61], 1.21 [1.01-1.45], and 1.27 [1.03-1.73], respectively). TI-CAUi, TI-APc, and TI-CAUc were also independent predictors of the occurrence of intracranial hemorrhage after MT (OR [95% CI]: 1.15 [1.01-1.38], 1.14 [1.01-1.38], 1.25 [1.02-1.52], respectively).
The TIs of the MCA M1 segment on both ipsilateral and contralateral sides were associated with unfavourable outcomes after MT.
我们旨在量化大脑中动脉（MCA）的迂曲程度，并评估其对接受机械血栓切除术（MT）的急性 MCA 闭塞患者的影像学和临床结局的影响。
本回顾性研究纳入了 53 例因 MCA M1 或 M2 段闭塞导致急性缺血性脑卒中的患者，这些患者均接受了支架取栓器（SR）治疗。迂曲指数（TI）用于量化 MCA M1 段的迂曲程度，公式如下：（实际距离/直线距离）×100。对于每个患者，使用磁共振血管造影（MRA）或计算机断层血管造影（CTA）在前后位和尾位分别测量患侧和对侧MCA 的四个 TI（分别为 TI-APi、TI-APc、TI-CAUi 和 TI-CAUc）。我们将首次通过效应（FPE）定义为首次通过 mTICI 分级≥2b 再灌注。
未达到 FPE 的患者的 TI-APi（112 比 106；=0.004）、TI-APc（111 比 105；=0.005）、TI-CAUi（110 比 105；=0.002）和 TI-CAUc（110 比 105；=0.001）明显更高。多变量分析显示，较高的 TI-APi、TI-CAUi 和 TI-APc 与 FPE 成功率降低独立相关（比值比[OR] [95%置信区间（CI）]：1.25 [1.02-1.61]、1.21 [1.01-1.45]和 1.27 [1.03-1.73]）。TI-CAUi、TI-APc 和 TI-CAUc 也是 MT 后颅内出血发生的独立预测因子（OR [95%CI]：1.15 [1.01-1.38]、1.14 [1.01-1.38]和 1.25 [1.02-1.52]）。
MCA M1 段的 TI 与 MT 后的不良结局相关。
