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Association between M1 tortuosity and intracranial hemorrhage after mechanical thrombectomy using a stent retriever
Rikuo Nishii1, Satoru Fujiwara2, Yasuhiro Yamamoto3
1Department of Neurovascular Research, Kobe City Medical Center General Hospital, Hyogo, Japan.
Abstract:
BackgroundMechanical thrombectomy (MT) is an important treatment for middle cerebral artery (MCA) M2 occlusions. However, it carries a risk of intracranial hemorrhage (ICH), especially with a stent retriever. We investigated the correlation between MCA M1 tortuosity and ICH after MT using a stent retriever for M2 occlusions, along with other clinical outcomes.MethodsThis single-center, retrospective study included patients with isolated MCA M2 occlusions treated using a stent retriever. M1 tortuosity was assessed using pre-MT imaging, with patients classified into tortuous (≥ 2 angulations) and non-tortuous (≤ 1 angulation) groups. The primary outcome was any ICH. Secondary outcomes included symptomatic ICH (sICH), procedural outcomes, and functional outcomes.ResultsAmong 153 patients (median age: 78 years, 48% female), 55 (36%) had tortuous M1 segments. The tortuous group showed higher NIHSS scores (median score 19 vs. 14, p = 0.045) and a higher prevalence of chronic renal failure at baseline (15% vs. 4%, p = 0.029). Any ICH occurred in 69 patients (45%) and was more frequent in the tortuous group (64% vs. 35%, p = 0.003; adjusted odds ratio [aOR], 3.09; 95% confidence interval [CI], 1.48-6.42). Among the ICH subtypes, subarachnoid hemorrhage (SAH) was more common in the tortuous group (49% vs. 27%, p = 0.01; aOR, 2.61; 95% CI, 1.26-5.41). However, the incidence of sICH (5.5% vs. 4.1%, p = 0.70) and good neurological outcome at 90 days after MT (45% vs. 50%, p = 0.62) were comparable.ConclusionMCA M1 tortuosity was associated with a higher incidence of any ICH, particularly SAH, after MT using a stent retriever for M2 occlusions.
Insights
Mechanical thrombectomy for middle cerebral artery M2 occlusions is effective but carries risks. Increased M1 tortuosity correlates with higher rates of intracranial hemorrhage, particularly subarachnoid hemorrhage, after stent retriever use.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Mechanical thrombectomy (MT) is a key treatment for middle cerebral artery (MCA) M2 occlusions.
- Stent retrievers, commonly used in MT, are associated with intracranial hemorrhage (ICH).
- The impact of arterial tortuosity on MT outcomes requires further investigation.
Purpose of the Study:
- To investigate the association between MCA M1 segment tortuosity and the occurrence of ICH after MT for M2 occlusions.
- To evaluate the correlation between M1 tortuosity and other procedural and clinical outcomes.
- To identify risk factors for ICH in patients undergoing MT for MCA M2 occlusions.
Main Methods:
- Retrospective, single-center study of 153 patients with isolated MCA M2 occlusions treated with stent retrievers.
- Classification of MCA M1 segments into tortuous (≥ 2 angulations) and non-tortuous (≤ 1 angulation) based on pre-MT imaging.
- Primary outcome: any ICH; Secondary outcomes: symptomatic ICH (sICH), procedural success, and 90-day functional outcomes.
Main Results:
- 55% of patients had tortuous M1 segments, associated with higher NIHSS scores and chronic renal failure.
- Any ICH occurred in 45% of patients, significantly more frequent in the tortuous group (64% vs. 35%; aOR, 3.09).
- Subarachnoid hemorrhage (SAH) was more common in the tortuous group (49% vs. 27%; aOR, 2.61), but sICH and 90-day outcomes were comparable.
Conclusions:
- MCA M1 tortuosity is a significant predictor of increased ICH incidence, especially SAH, following MT for M2 occlusions using stent retrievers.
- While tortuosity increases the risk of any ICH and SAH, it does not appear to affect symptomatic ICH or long-term functional outcomes.
- Pre-procedural assessment of M1 tortuosity may aid in risk stratification and patient selection for MT.
