conference abstract Open access
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Introduction Stroke is one of the leading causes for neurological disability and death worldwide. Specifically, acute ischemic strokes (AIS) account for most cases encountered by interventionists. Interventionists are challenged with effectively diagnosing and treating AIS patients within a narrow timeframe. The time taken to access carotid vasculature and begin recanalization is dictated by the availability of information regarding vascular anatomy and trajectory. Currently, there is only a handful of published data regarding the influence of vessel radius of curvature and tortuosity on internal carotid access time. The absence of such information potentially impacts device selection, procedure success, and stroke outcomes. While the cervical carotid vessels allow interventionists to navigate catheters to the site of the occlusion, procedures are often encumbered if the pathway exhibits tortuosity. The purpose of this retrospective study was to determine how neurointerventionalists consider the physical nature of carotid segments when evaluating a procedure’s difficulty. Methods Seven interventional neuroradiologists reviewed 3D reconstructions of CT angiograms of left and right carotid arteries from 49 subjects and rated how challenging the procedure would be on a three-point scale (easy, medium, difficult) to reach the targeted proximal M1 with a thrombectomy device. Fifteen vessel metrics were quantified by dividing the carotids into 5 segments (figure 1) and measuring the radius of curvature, tortuosity, and vessel length of each segment. Results The tortuosity and length of the arch-cervical and cervical regions significantly impacted difficulty ratings, i.e. longer and more tortuous segments will lose device length affecting the support of the device, thus increasing the procedure difficulty. Additionally, a two-way interaction between the radius of curvature and tortuosity on the arch-cervical region was significant (p<0.0001) wherein an inverse relationship was established (table 1). For example, at a given arch-cervical tortuosity, an increased radius of curvature reduced case difficulty. Conclusions Examining these vessel qualities can enable procedures to be tailored to patient characteristics. Prioritizing detailed cerebral vasculature data for physician use can allow for better interventional preparation, facilitate faster vessel access time, and improve thrombectomy outcomes. Additionally, documenting these correlations can enhance device design to ensure they suitably function under various vessel conditions. Disclosures M. Shazeeb: None. V. Moholkar: None. R. King: None. A. Kuhn: None. S. Vedantham: None. Z. Vardar: None. A. Kraitem: None. V. Anagnostakou: None. J. Singh: None. F. Massari: None. K. de Macedo Rodrigues: None. V. Naragum: None. A. Puri: None. M. Gounis: None.
TL;DRA two-way interaction between the radius of curvature and tortuosity on the arch-cervical region was significant (p<0.0001) wherein an inverse relationship was established. (Semantic Scholar)