Artificial Intelligence-Derived Carotid Elongation Ratio May Predict Procedural Delay but Offers Limited Prognostic
Julien Ognard1,2, Pere Canals3,4, Jiahui Li3
1From the Univ Brest (J.O.), LATIM, INSERM UMR1101, CHU Brest, Brest, France ognard.julien@mayo.edu.
Insights
Carotid elongation ratio (CER) is associated with longer mechanical thrombectomy times but does not independently predict outcomes. CER may help anticipate technical challenges, particularly in older stroke patients.
Area of Science:
- Neuroendovascular surgery
- Stroke imaging analysis
- Clinical outcomes research
Background:
- Carotid artery tortuosity (CAT) can complicate mechanical thrombectomy (MT) for acute ischemic stroke.
- The carotid elongation ratio (CER) quantifies CAT, but its independent predictive value for MT efficiency and patient outcomes is unclear.
Purpose of the Study:
- To evaluate if the carotid elongation ratio (CER) independently predicts procedural efficiency and 90-day functional outcomes in patients undergoing mechanical thrombectomy (MT).
Main Methods:
- Retrospective analysis of 412 patients undergoing MT for anterior circulation stroke.
- AI-based algorithm computed CER from pre-treatment CT angiography.
- Statistical analyses included correlation, quartile comparison, and multivariable regression; mediation analysis assessed age-related procedural time.
Main Results:
- Mean CER was 1.33 ± 0.15.
- Higher CER correlated with longer procedure times (p=0.049) but not reperfusion success.
- Univariate analysis showed association with worse 90-day outcomes (p=0.001), but CER was not an independent predictor after adjustment (p=0.77).
- CER mediated the relationship between age and procedural time (p=0.047).
Conclusions:
- Carotid elongation ratio (CER) is linked to procedural delays and unadjusted outcome associations in MT.
- CER is not an independent predictor of 90-day functional outcomes (mRS).
- CER's clinical utility is in identifying potential technical difficulties, especially in elderly patients.
Background And Purpose:
Carotid artery tortuosity, quantified by the carotid elongation ratio (CER), may hinder mechanical thrombectomy (MT). We evaluated whether CER independently predicts procedural efficiency and 90-day functional outcome.
Materials And Methods:
We retrospectively analyzed data from 412 patients from the Vall d'Hebron University Hospital prospectively maintained registry, who underwent MT for anterior circulation acute ischemic stroke between 2017 and 2023. CER was computed from pretreatment CTA using an artificial intelligence-based centerline algorithm. Associations with procedural time (groin-to-reperfusion) and 90-day mRS were assessed via correlation, quartile comparison, and multivariable logistic regression adjusted for confounders. Mediation analysis tested whether CER mediates the effect of age on procedural time.
Results:
Mean CER was 1.33 ± 0.15. CER correlated with longer procedure time (ρ = 0.11; P = .049), but not with final reperfusion success or number of passes. In univariate analysis, higher CER was associated with worse 90-day outcome (mRS 0-2 versus 3-6: 1.30 versus 1.35; P = .001), and quartile analysis showed a significant trend (P = .004). However, CER was not independently predictive after adjustment (adjusted OR per 0.1 CER = 0.97, 95% CI, 0.80-1.18; P = .77). Mediation analysis showed CER significantly mediated the relationship between age and procedural time (indirect effect = +0.13 min/y, Sobel P = .047).
Conclusions:
While CER is associated with procedural delay and outcome in unadjusted analyses, it is not an independent predictor of 90-day mRS. Its clinical relevance lies in anticipating technical difficulty, especially in older patients.
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