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Related Experiment Video

Updated: Jun 20, 2025

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

A thoracic CT imaging parameter predicting access difficulty in acute stroke thrombectomy.

Hiroto Yamaoka¹, Sakyo Hirai¹, Ryoichi Hanazawa²

¹Department of Endovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, Bunkyo-ku 113-8519, Japan.

Clinical Neurology and Neurosurgery

|July 22, 2024

Summary

A new imaging parameter, the distance from the sternum to the ascending aorta (S-AAD), can predict difficult vascular access for mechanical thrombectomy (MT). A smaller S-AAD indicates higher risk, aiding pre-procedural planning.

Keywords:

Access difficulty Aortic arch Ischemic stroke Mechanical thrombectomy S-AAD

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Area of Science:

Interventional Neurology
Medical Imaging
Vascular Surgery

Background:

Mechanical thrombectomy (MT) requires timely vascular access for acute stroke treatment.
Aortic arch geometry and age-related changes can complicate access.
Predictive imaging markers for access difficulty are needed.

Purpose of the Study:

To evaluate the distance from the sternum to the ascending aorta (S-AAD) as an imaging parameter for predicting vascular access difficulty in MT.
To correlate S-AAD with guiding time (GT) during MT procedures.

Main Methods:

Retrospective observational study of 115 patients undergoing MT for anterior circulation large-vessel occlusion.
S-AAD measured on pre-procedural chest CT scans.
Difficult access defined as guiding time (GT) ≥ 30 minutes; patients grouped into short GT (sGT) and long GT (lGT).

Main Results:

A significant difference in S-AAD was observed between sGT and lGT groups (median S-AAD: 11.9 mm vs. 6.6 mm, P=0.026).
Dyslipidemia and S-AAD < 5 mm were significantly associated with difficult access (OR 5.938 and 5.147, respectively).
10.4% of patients experienced difficult access (lGT).

Conclusions:

S-AAD is a simple, reliable imaging parameter for predicting vascular access difficulty in MT.
This parameter can assist in selecting appropriate devices and access routes pre-interventionally.
Utilizing S-AAD may improve MT procedural efficiency and success rates.