Impact of Intracranial Vessel Tortuosity on Mechanical Thrombectomy Outcomes in Acute Ischemic Stroke: A Systematic Review
Mohamed Derhab1, Omar Elmandouh2, Abdelrahman Hamouda1, Mark Cwajna1, Nicholas Kendall1, Ahmad Ali3, Sherief Ghozy1, David Kallmes1
1Mayo Clinic, 2Neurology, Cooper University, 3Rutgers University
Objective:
This systematic review evaluates the impact of intracranial vessel tortuosity on outcomes of mechanical thrombectomy in AIS patients, focusing on recanalization success, hemorrhagic complications, and functional recovery.
Background:
Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality. Mechanical thrombectomy (MT) is the standard of care for large vessel occlusions (LVO), but anatomical factors like intracranial vessel tortuosity can influence procedural success.
Design/Methods:
We conducted a systematic review following PRISMA guidelines across PubMed, EMBASE, Scopus, and Web of Science until August 2024. Studies were included if they demonstrate the effect of intracranial vessel tortuosity on MT outcomes.
Results:
Of the 321 identified studies, 16 met the inclusion criteria, comprising 3,879 patients. Fourteen studies focused exclusively on the anterior circulation, one on the posterior circulation, and one examined both circulations. Vessel tortuosity significantly impacted thrombectomy success, with lower recanalization rates, particularly when aspiration techniques were employed. The absolute difference in recanalization success rates ranged between 29% and 55% in the anterior circulation, comparing highly tortuous vessels to less tortuous ones. The internal carotid artery (ICA) and middle cerebral artery (MCA) were the most frequently occluded vessels, both of which are especially prone to tortuosity, adding procedural complexity. While some studies reported increased hemorrhagic complications in highly tortuous vessels, findings were inconsistent. Data on functional recovery were limited, preventing definitive conclusions about the influence of tortuosity on long-term outcomes.
Conclusions:
Intracranial vessel tortuosity reduces recanalization success and increases procedural challenges, especially in the anterior circulation. Its impact on complications and long-term outcomes remains unclear, highlighting the need for further research.
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