• Santiago Gomez-Paz, Yosuke Akamatsu, Akashleena Mallick, Noah J Jordan, Mohamed M Salem, Alejandro Enriquez-Marulanda, Ajith J Thomas, Christopher S Ogilvy, and Justin M Moore.
• Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
• World Neurosurg. 2021 Aug 1; 152: e1-e10.

ObjectiveThe literature is scarce for studies evaluating the anatomy of cervical vessels in patients with stroke. We sought to investigate the effect of vessel tortuosity in procedural, angiographic, and functional outcomes in patients with acute ischemic stroke treated with mechanical thrombectomy (MT).MethodsPatients with an emergent large vessel occlusion of the anterior circulation treated with MT between 2015 and 2020 were included. The tortuosity of the internal carotid artery was recorded as the tortuosity index (TI) using the following formula: [(actual/straight length-1) × 100). A multivariable regression was performed to assess procedural, angiographic, and functional outcomes based on the TI.ResultsA total of 212 patients were included. Median age was 72 years (interquartile range, 62-82 years); admission National Institutes of Health Stroke Scale score was 17 ± 6. Median TI was 7.9 (interquartile range, 3.7-19.7). A total of 127 patients (60%) had a TI <10. Early reperfusion (procedure time <60 minutes) was accomplished in 144 patients (67.9%). A multivariable analysis showed that patients with a TI <10 were more likely to achieve an early reperfusion (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.11-4.78; P = 0.025). A TI <10 was a predictor of successful reperfusion (OR, 2.0; CI, 1.05-3.93; P = 0.035) and an early reperfusion was the sole predictor of functional independence (most recent modified Rankin Scale score 0-2) (OR, 4.1; 95% CI, 1.62-10.53; adjusted P = 0.003).ConclusionsPatients with a TI <10 are significantly more likely to achieve early successful reperfusion after MT for the treatment of acute ischemic stroke.Copyright © 2021 Elsevier Inc. All rights reserved.

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