Vascular tortuosity in endovascular mechanical thrombectomy

Area of Science:

• Neuroendovascular surgery
• Medical imaging analysis
• Stroke intervention

Background:

• Endovascular mechanical thrombectomy is effective for acute ischemic stroke (AIS).
• Vascular geometry, such as angulation and tortuosity, can impede device navigation.
• Limited literature addresses the impact of carotid artery anatomy on thrombectomy success.

Purpose of the Study:

• To evaluate the influence of carotid artery catheter pathway accessibility on thrombectomy outcomes in AIS patients.
• To highlight the utility of novel 3D imaging techniques for assessing vascular geometry.
• To correlate anatomical variants with procedural challenges and potential treatment strategies.

Main Methods:

• Review of literature from PubMed, Embase, and Web of Science on thrombectomy applications.
• Analysis of 3D computed tomography angiography (CTA) for accurate tortuosity and angulation measurements.
• Semi-automated measurement techniques to quantify arterial loops and bilateral angulation differences.

Main Results:

• Significant carotid artery angulation correlates with delays in reaching occlusion sites.
• Increased age is associated with greater vascular tortuosity.
• Approximately 3% of analyzed pathways exhibited full 360° arterial loops.

Conclusions:

• Accurate 3D imaging analysis of vascular geometry is crucial for neuroendovascular thrombectomy planning.
• Identifying specific anatomical variants can guide the selection of tailored catheter devices.
• Understanding vessel tortuosity improves procedural efficiency and potentially patient outcomes in AIS.