TY - JOUR
T1 - Assessment of thrombectomy procedure difficulty by neurointerventionalists based on vessel geometry parameters from carotid artery 3D reconstructions
AU - Shazeeb, Mohammed Salman
AU - Moholkar, Viraj
AU - King, Robert M.
AU - Vedantham, Srinivasan
AU - Vardar, Zeynep
AU - Kraitem, Afif
AU - Lindsay, Clifford
AU - Anagnostakou, Vania
AU - Singh, Jasmeet
AU - Massari, Francesco
AU - de Macedo Rodrigues, Katyucia
AU - Naragum, Varun
AU - Puri, Ajit S.
AU - Carniato, Sarena
AU - Gounis, Matthew J.
AU - Kühn, Anna Luisa
N1 - Funding Information:
This work was sponsored in part by Stryker Neurovascular. The content is solely the responsibility of the authors and does not necessarily represent the official views of the sponsors. The sponsor was not involved with study design, collection, analysis and interpretation of data nor the writing or submission of the manuscript.
Publisher Copyright:
© 2023 Elsevier Ltd
PY - 2023/7
Y1 - 2023/7
N2 - Background: Diagnosing and treating acute ischemic stroke patients within a narrow timeframe is challenging. Time needed to access the occluded vessel and initiate thrombectomy is dictated by the availability of information regarding vascular anatomy and trajectory. Absence of such information potentially impacts device selection, procedure success, and stroke outcomes. While the cervical vessels allow neurointerventionalists to navigate devices to the occlusion site, procedures are often encumbered due to tortuous pathways. The purpose of this retrospective study was to determine how neurointerventionalists consider the physical nature of carotid segments when evaluating a procedure's difficulty. Methods: Seven neurointerventionalists reviewed 3D reconstructions of CT angiograms of left and right carotid arteries from 49 subjects and rated the perceived procedural difficulty on a three-point scale (easy, medium, difficult) to reach the targeted M1. Twenty-two vessel metrics were quantified by dividing the carotids into 5 segments and measuring the radius of curvature, tortuosity, vessel radius, and vessel length of each segment. Results: The tortuosity and length of the arch-cervical and cervical regions significantly impacted difficulty ratings. Additionally, two-way interaction between the radius of curvature and tortuosity on the arch-cervical region was significant (p < 0.0001) wherein, for example, at a given arch-cervical tortuosity, an increased radius of curvature reduced the perceived case difficulty. Conclusions: Examining the vessel metrics and providing detailed vascular data tailored to patient characteristics may result in better procedure preparation, facilitate faster vessel access time, and improve thrombectomy outcomes. Additionally, documenting these correlations can enhance device design to ensure they suitably function under various vessel conditions.
AB - Background: Diagnosing and treating acute ischemic stroke patients within a narrow timeframe is challenging. Time needed to access the occluded vessel and initiate thrombectomy is dictated by the availability of information regarding vascular anatomy and trajectory. Absence of such information potentially impacts device selection, procedure success, and stroke outcomes. While the cervical vessels allow neurointerventionalists to navigate devices to the occlusion site, procedures are often encumbered due to tortuous pathways. The purpose of this retrospective study was to determine how neurointerventionalists consider the physical nature of carotid segments when evaluating a procedure's difficulty. Methods: Seven neurointerventionalists reviewed 3D reconstructions of CT angiograms of left and right carotid arteries from 49 subjects and rated the perceived procedural difficulty on a three-point scale (easy, medium, difficult) to reach the targeted M1. Twenty-two vessel metrics were quantified by dividing the carotids into 5 segments and measuring the radius of curvature, tortuosity, vessel radius, and vessel length of each segment. Results: The tortuosity and length of the arch-cervical and cervical regions significantly impacted difficulty ratings. Additionally, two-way interaction between the radius of curvature and tortuosity on the arch-cervical region was significant (p < 0.0001) wherein, for example, at a given arch-cervical tortuosity, an increased radius of curvature reduced the perceived case difficulty. Conclusions: Examining the vessel metrics and providing detailed vascular data tailored to patient characteristics may result in better procedure preparation, facilitate faster vessel access time, and improve thrombectomy outcomes. Additionally, documenting these correlations can enhance device design to ensure they suitably function under various vessel conditions.
KW - Acute ischemic stroke
KW - Rater assessment
KW - Thrombectomy
KW - Tortuosity
KW - Vessel geometry
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U2 - 10.1016/j.jocn.2023.05.014
DO - 10.1016/j.jocn.2023.05.014
M3 - Article
C2 - 37262981
AN - SCOPUS:85160554666
SN - 0967-5868
VL - 113
SP - 121
EP - 125
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
ER -