Affiliation:
1. Department of Neurology Korea University Ansan Hospital Korea University College of Medicine Ansan South Korea
2. Department of Neurosurgery Haeundae Paik Hospital, Inje University Busan South Korea
3. Department of Radiology Asan Medical Center University of Ulsan College of Medicine Seoul South Korea
4. Department of Neurology Asan Medical Center University of Ulsan College of Medicine Seoul South Korea
5. Department of Neurology Gangneung Asan Hospital University of Ulsan College of Medicine Gangneung South Korea
Abstract
Background
Vascular tortuosity affects the outcomes of mechanical thrombectomy (MT). We classified vertebral artery (VA) tortuosity into 3 types and investigated the effect of VA tortuosity on the outcomes in patients with basilar artery occlusion.
Methods
We retrospectively included patients who underwent MT for basilar artery occlusion between January 2012 and May 2022. Clinical and procedure‐related factors were obtained. VA tortuosity was classified into 3 types: type I: nontortuous VA; type II: S‐shaped vessel or a VA with a single acute angulation (<90°); and type III: coiled vessel, kinked vessel, or a VA with acute angulation in >1 location. The 3‐month modified Rankin scale, procedural outcomes, and post‐MT intracranial hemorrhage were assessed.
Results
A total of 106 patients with basilar artery occlusion were included. Age, baseline stroke severity, and 3‐month modified Rankin scale score were significantly different according to VA tortuosity (
P
= 0.003,
P
= 0.002, and
P
<0.001, respectively). A multivariable analysis demonstrated that the VA tortuosity was a predictor for the achievement of modified Rankin scale score of 0 to 3 (type I: reference; type II: odds ratio [OR] = 0.26, 95% CI = 0.07–0.95,
P
= 0.041; type III: OR = 0.12, 95% CI = 0.02–0.82,
P
= 0.031). Moreover, type III was associated with less successful recanalization (type I: reference; type III: OR = 0.12, 95% CI = 0.02–0.84,
P
= 0.032) and had a potential trend for post‐MT intracranial hemorrhage (type I: reference; type III: OR = 3.09, 95% CI = 0.83–11.56,
P
= 0.094).
Conclusion
We classified VA tortuosity into 3 types and showed the association between VA tortuosity and stroke outcomes after MT for basilar artery occlusion. Particularly, the mechanisms of poor outcomes in highly tortuous VA might be associated with baseline stroke severity, recanalization failure, and post‐MT intracranial hemorrhage.
Publisher
Ovid Technologies (Wolters Kluwer Health)