The prognostic value of extracranial vascular characteristics on procedural duration and revascularization success in endovascularly treated acute ischemic stroke patients

G. Holswilder*, M. P. M. E. Stuart, T. Dompeling, N. D. Kruyt, J. J. Goeman, A. van der Lugt, W. J. Schonewille, G. J. Lycklama à Nijeholt, C. B. L. M. Majoie, L. S. F. Yo, F. J. A. Meijer, H. A. Marquering, M. J. H. Wermer, M. A. A. van Walderveen

*Corresponding author for this work

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Abstract

Introduction: Vascular anatomy might affect endovascular treatment success in acute ischemic stroke patients with large vessel occlusion. We investigated the prognostic value of extracranial vascular characteristics on procedural time and revascularization success in patients with large vessel occlusion in the anterior cerebral circulation. Patients and methods: We included 828 patients endovascularly treated within 6.5 hours of symptom onset from the Dutch MR CLEAN-Registry. We evaluated aortic arch configuration, stenosis and tortuosity of supra-aortic arteries, and internal carotid arteries (ICAs) on pre-intervention CTA. We constructed logistic prediction models for outcome variables procedural duration (≥60 minutes) and non-successful revascularization (extended thrombolysis in cerebral infarction (eTICI) of 0–2A) using baseline characteristics and assessed the effect of extracranial vascular characteristics on model performance. Results: Cervical ICA tortuosity and stenosis ≥99% improved prediction of long procedural duration compared with baseline characteristics from area under the curve of 0.61 (95% CI: 0.57–0.65) to 0.66 (95% CI: 0.62–0.70) (P < 0.001). Cervical ICA tortuosity was significantly associated with non-successful recanalization. Prediction of non-successful revascularization did not improve after including aortic arch elongation, acute take-off angle, aortic variant, origin stenosis of supra-aortic arteries, and cervical ICA tortuosity, with an area under the curve of 0.63 (95% CI: 0.59–0.67) compared with 0.59 (95% CI: 0.55–0.63) (P = 0.11). Conclusion: Extracranial vascular characteristics have additional prognostic value for procedural duration, but not for revascularization success, compared with baseline characteristics. Performance of both prediction models is limited in patients treated for large vessel occlusion.

Original languageEnglish
Pages (from-to)48-56
Number of pages9
JournalEuropean Stroke Journal
Volume7
Issue number1
DOIs
Publication statusPublished - Mar 2022

Bibliographical note

Funding Information:
The MR CLEAN Registry was partly funded by TWIN Foundation, Erasmus MC University Medical Center, Maastricht University Medical Center, and Amsterdam UMC.

Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AL received grants from: Cerenovus, Penumbra, Stryker, Medtronic, Dutch Heart Foundation, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health and from Dutch Brain Foundation. CBLMM received grants during the conduct of the study (paid to institution) from TWIN Foundation and outside of the submitted work (paid to institution) from CVON/Dutch Heart Foundation, European Commission, Dutch Health Evaluation Program and from Stryker; and is shareholder of Nico.Lab. HAM is co-founder and shareholder of Nico.Lab. GH, MPMES, TD, NDK, JJG, WJS, GJLN, LSFY, FJAM, MJHW and MAAW declared no conflict interest.

Publisher Copyright:
© European Stroke Organisation 2022.

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