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Semi-automated measurement of vascular tortuosity and its implications for mechanical thrombectomy performance

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

Few studies have examined the geometry of endovascular mechanical thrombectomy pathways. Here we examine the tortuosity and angulations of catheter pathways from the aortic arch to the termination of the internal carotid artery (ICA) and its association with thrombectomy performance.

Methods

We included 100 consecutive anterior circulation large vessel occlusion thrombectomy patients over 12 months. Computed tomography angiograms (CTA) were used for 3D segmentation of catheter pathway from the aortic arch to ICA termination. Tortuosity index (TI) and angulations of the catheter pathway were measured in a semi-automated fashion. TI and angulation degree were compared between sides and correlated with age and procedural measures.

Results

We analyzed 188 catheter pathways in 100 patients. Severe angulation (≤ 30°) was present in 5.8% and 39.4% of common carotid artery (CCA) and extracranial ICA segments, respectively. Five pathways (2.6%) had 360° loop. CCA and extracranial ICA tortuosity had a weak but significant correlation with age (r = 0.17, 0.21, p value = 0.05, 0.02 respectively), time from groin puncture to the site of occlusion (r = 0.29, 0.25, p values = 0.008, 0.026 respectively), and fluoroscopy time (r = 0.022, 0.31, p values = 0.016, 0.001 respectively). There was a significant difference in the pattern of angulation (p value = 0.04) and tortuosity between right and left side in CCA segment (TI = 0.20 ± 0.086 vs. 0.15 ± 0.82, p value < 0.001).

Conclusions

There was a significant difference in CCA angulation between right and left sides. TI of extracranial CCA and ICA correlated with age and influenced time from groin puncture to the occlusion site and total fluoroscopy time.

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Funding

This work was supported in part by the NIH grant 1R21NS109575.

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Authors and Affiliations

  1. Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA

    Maxim Mokin & Cesario V. Borlongan

  2. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA

    Muhammad Waqas, Felix Chin, Hamid Rai, Elad I. Levy & Adnan H. Siddiqui

  3. Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA

    Muhammad Waqas, Felix Chin, Hamid Rai, Elad I. Levy & Adnan H. Siddiqui

  4. Jacobs Institute, Buffalo, NY, USA

    Jillian Senko, Adam Sparks, Richard W. Ducharme & Michael Springer

  5. Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA

    Ciprian Ionita

Authors
  1. Maxim Mokin
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  2. Muhammad Waqas
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  3. Felix Chin
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  4. Hamid Rai
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  5. Jillian Senko
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  8. Michael Springer
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  9. Cesario V. Borlongan
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  10. Elad I. Levy
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  12. Adnan H. Siddiqui
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Corresponding author

Correspondence to Adnan H. Siddiqui.

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Conflict of interest

Levy—Shareholder/Ownership Interests: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care (formerly the Stroke Project), Rebound Therapeutics, StimMed, Three Rivers Medical; National Principal Investigator/Steering Committees: Medtronic (merged with Covidien Neurovascular) SWIFT Prime and SWIFT Direct Trials; Honoraria: Medtronic (training and lectures); Consultant: Claret Medical, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, Rebound, StimMed; Advisory Board: Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical, Endostream Medical; Site Principal Investigator: CONFIDENCE study (MicroVention), STRATIS Study—Sub I (Medtronic).

Siddiqui—Research Grant: NIH/NINDS 1R01NS091075 as a co-investigator for Virtual Intervention of Intracranial Aneurysms; Financial Interest/Investor/Stock Options/Ownership: Amnis Therapeutics, Apama Medical, Blink TBI Inc., Buffalo Technology Partners Inc., Cardinal Consultants, Cerebrotech Medical Systems, Inc. Cognition Medical, Endostream Medical Ltd., Imperative Care, International Medical Distribution Partners, Neurovascular Diagnostics Inc., Q’Apel Medical Inc, Rebound Therapeutics Corp., Rist Neurovascular Inc., Serenity Medical Inc., Silk Road Medical, StimMed, Synchron, Three Rivers Medical Inc., Viseon Spine Inc; Consultant/Advisory Board: Amnis Therapeutics, Boston Scientific, Canon Medical Systems USA Inc., Cerebrotech Medical Systems Inc., Cerenovus, Corindus Inc., Endostream Medical Ltd., Guidepoint Global Consulting, Imperative Care, Integra LifeSciences Corp., Medtronic, MicroVention, Northwest University–DSMB Chair for HEAT Trial, Penumbra, Q’Apel Medical Inc., Rapid Medical, Rebound Therapeutics Corp., Serenity Medical Inc., Silk Road Medical, StimMed, Stryker, Three Rivers Medical, Inc., VasSol, W.L. Gore & Associates; Principal Investigator/Steering Comment of the Following Trials: Cerenovus NAPA and ARISE II; Medtronic SWIFT PRIME and SWIFT DIRECT; MicroVention FRED & CONFIDENCE; MUSC POSITIVE; and Penumbra 3D Separator, COMPASS, and INVEST.

Borlongan—Funded and received royalties and stock options from Astellas, Asterias, Sanbio, Athersys, KMPHC, and International Stem Cell Corporation; and also received consultant compensation for Chiesi Farmaceutici.

Mokin—Consultant: Canon, Cerebrotech, Imperative care. Investor: Serenity Medical.

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Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Mokin, M., Waqas, M., Chin, F. et al. Semi-automated measurement of vascular tortuosity and its implications for mechanical thrombectomy performance. Neuroradiology 63, 381–389 (2021). https://doi.org/10.1007/s00234-020-02525-6

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  • DOI: https://doi.org/10.1007/s00234-020-02525-6

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