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Related Experiment Video

Updated: Jul 10, 2026

Optimization of the Longa Middle Cerebral Artery Occlusion Method for Complete Reperfusion
13:18

Optimization of the Longa Middle Cerebral Artery Occlusion Method for Complete Reperfusion

Published on: November 22, 2024

Practical Tortuosity Index Is Associated with Complete Recanalization in Distal M2 Thrombectomy: The D-MOTIVE Study.

Luis Fernández-Espigares1, Diego Villagrán-Sancho1, Antonio Pulido Bonillo1

  • 1From the Department of Neurology (L.F.-E., C.V.R., L.M.-H.), Neurology (D.V.-S., M.M.-R., J.A.C.-R., A.H.-G., F.M.), Neurovascular Laboratory (D.V.-S., C.V.-R., L.M.-H., M.M.-R., J.A.C.-R., A.H.-G., R.O.-P., H.A.-R., A.D.A.-C., M.A.-P., A.G., F.M., E.Z.-A), Instituto de Biomedicina de Sevilla (IBiS)/University Hospital, Radiology (A.P.B., R.O.-P., P.P.-G.), Seville Health Research Management Foundation (FISEVI) (H.A.-R.), Radiology (A.D.A.-C., M.A.-P., A.G., E.Z.-A.), Interventional Neuroradiology, Virgen del Rocío University Hospital, Sevilla, Spain and Hospital Regional de Ñuble (A.N.-A.). Servicio de Salud Ñuble. Chillán. Chile.

AJNR. American Journal of Neuroradiology
|July 8, 2026
PubMed

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Summary

Higher sagittal M2 tortuosity in distal medium-vessel occlusions is linked to poorer mechanical thrombectomy outcomes. This CTA metric may help identify patients unlikely to benefit from the procedure.

Area of Science:

  • Neurology
  • Interventional Radiology
  • Medical Imaging

Background:

  • Mechanical thrombectomy is a key treatment for acute ischemic stroke.
  • Optimal patient selection for mechanical thrombectomy in distal medium-vessel occlusions (M2) remains challenging.
  • Anatomical factors influencing procedural success in M2 occlusions are not fully understood.

Purpose of the Study:

  • To evaluate the association between simple Computed Tomography Angiography (CTA)-derived metrics and recanalization rates.
  • To determine if CTA metrics correlate with clinical outcomes in patients undergoing mechanical thrombectomy for distal M2 occlusions.
  • To explore the utility of anatomical factors in predicting thrombectomy success.

Main Methods:

  • Retrospective cohort study (D-MOTIVE) of patients treated with mechanical thrombectomy for distal M2 occlusions.

Related Experiment Videos

Last Updated: Jul 10, 2026

Optimization of the Longa Middle Cerebral Artery Occlusion Method for Complete Reperfusion
13:18

Optimization of the Longa Middle Cerebral Artery Occlusion Method for Complete Reperfusion

Published on: November 22, 2024

  • Analysis of baseline CTA scans for anatomical metrics, including sagittal M2 tortuosity index and vessel angulations.
  • Receiver operating characteristic (ROC) analyses to assess the discriminative performance of anatomical metrics for recanalization and functional outcomes.

    • Main Results:

    • High sagittal M2 tortuosity (index ≥ 1.19) was associated with significantly lower rates of complete recanalization (39% vs. 70%).
    • Patients with high tortuosity had reduced first-pass effect and fewer achieved functional independence (mRS 0-2) at 90 days (16.7% vs. 72.7%).
    • Adjusted analyses confirmed high tortuosity was linked to lower recanalization odds, more device passes, and worse functional outcomes.

    Conclusions:

    • Increased sagittal M2 tortuosity is a significant predictor of lower recanalization rates and poorer 90-day outcomes after mechanical thrombectomy for distal M2 occlusions.
    • Simple CTA-based anatomical markers, like sagittal M2 tortuosity, are readily available and may aid in patient selection.
    • These findings require external validation but suggest a potential role for CTA metrics in identifying patients less likely to benefit from thrombectomy.