Impact of Aortic Arch Anatomy on Technical Performance and Clinical Outcomes in Patients with Acute Ischemic Stroke

Abstract

BACKGROUND AND PURPOSE: Arterial access is a technical consideration of mechanical thrombectomy that may affect procedural time, but few studies exist detailing the relationship of anatomy to procedural times and patient outcomes. We sought to investigate the respective impact of aortic arch and carotid artery anatomy on endovascular procedural times in patients with large-vessel occlusion. MATERIALS AND METHODS: We retrospectively reviewed imaging and medical records of 207 patients from 2 academic institutions who underwent mechanical thrombectomy for anterior circulation large-vessel occlusion from January 2015 to July 2018. Preintervention CTAs were assessed to measure features of the aortic arch and ipsilateral great vessel anatomy. These included the cranial-to-caudal distance from the origin of the innominate artery to the top of the aortic arch and the takeoff angle of the respective great vessel from the arch. mRS scores were calculated from rehabilitation and other outpatient documentation. We performed bootstrap, stepwise regressions to model groin puncture to reperfusion time and binary mRS outcomes (good outcome, mRS # 2). RESULTS: From our linear regression for groin puncture to reperfusion time, we found a significant association of the great vessel takeoff angle (P 4 .002) and caudal distance from the origin of the innominate artery to the top of the aortic arch (P 4 .05). Regression analysis for the binary mRS revealed a significant association with groin puncture to reperfusion time (P , .001). CONCLUSIONS: These results demonstrate that patients with larger takeoff angles and extreme aortic arches have an association with longer procedural times as approached from transfemoral access routes. ABBREVIATIONS: CCA 4 common carotid artery; CCIA 4 the cranial-to-caudal distance from the origin of the innominate artery to the top of the aortic arch; GPRT 4 groin puncture to reperfusion time; HTN 4 hypertension; LVO 4 large-vessel occlusion I schemic stroke is the fifth leading cause of death and the leading cause of long-term disability in the United States. 1 Recent studies have established mechanical thrombectomy as the criterion standard of care for large-vessel occlusion over tPA alone. 2-5 These and other studies have demonstrated that reduced time between the onset of symptoms and reperfusion leads to better clinical outcomes. 6,7 That time interval comprises prehospital

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

“…Our study confirms the associations between tortuosity of the cervical ICA and long procedural duration shown by others. 5,6 Moreover, other studies showed associations for aortic arch elongation and aortic variants, [5][6][7][8] which were not found in our population. This difference might be due to the relative low prevalence of severe aortic arch elongation (17%) compared with two other studies (30%-39%), 7,8 and the relatively low prevalence of aortic variant C (11%) in our study.…”

“…3 Current recommendations state that procedural time should not exceed 60 minutes and the target should be successful recanalization defined as restored antegrade flow of ≥50% of the territory of the previously occluded artery. 4 Recent studies demonstrated that unfavorable extracranial vascular anatomy, including complex configuration of the aortic arch and tortuosity of the supra-aortic vessels, prolongs procedural duration, [5][6][7] and negatively influences revascularization success. 5,7,8 However, these studies were performed with small sample sizes leaving uncertainty about the true association between vascular characteristics and procedural duration and revascularization success, especially in addition to baseline predictors.…”

Efficacy of Asahi Fubuki as a Guiding Catheter for Mechanical Thrombectomy: An Institutional Case Series

“…On logistic regression analysis, a type III aortic arch was the only patient characteristic associated with Fubuki failure, which was unsurprising given previous studies associating complicated arch anatomy with the inability to perform MT. 5 Nevertheless, as depicted in our representative case, the Fubuki was able to cross relatively tortuous arch anatomy while providing adequate support to complete the MT. In the future, more indepth anatomic analyses of MT cases may allow improved quantification of guide catheter performance and facilitate comparison among different catheters.…”

#RadialFirst and #RadialForNeuro: A descriptive analysis of Twitter conversations regarding transradial access

“…The articles with most interactions included a systematic review on transradial access, 11 and original research institutional studies. 21,22 English (98.2%) and Japanese (0.6%) were the most common languages utilized for the tweets. Physicians authored only 35.6% of the tweets, while 50.5% of accounts were from individuals whose careers were not specifically denoted by their profiles or biography and were listed as unknown.…”