Tortuosity Index Predicts Early Successful Reperfusion and Impacts Functional Status After Thrombectomy for Stroke.

OBJECTIVES Literature is scarce in studies evaluating the anatomy of cervical vessels in stroke patients. We sought to investigate the effect of the vessels' tortuosity in procedural, angiographic and functional outcomes in patients with acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT). MATERIALS AND METHODS Patients 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 (T.I.) using the following formula: [(actual/straight length - 1) X 100]. A multivariable regression was performed to assess procedural, angiographic and functional outcomes based on the T.I. RESULTS A total of 212 patients were included. Median age [IQR] was 72 [62-82]; Admission NIHSS score was 17 ± 6. Median T.I. was 7.9 [3.7 - 19.7]. 127 (60%) patients had a T.I. < 10. Early reperfusion (procedure time < 60 minutes) was accomplished in 144 (67.9%) patients. A multivariable analysis showed that patients with a T.I. < 10 were more likely to achieve an early reperfusion (O.R: 2.3, 95% CI 1.11 - 4.78; p = 0.025). A T.I. < 10 was a predictor of successful reperfusion (O.R 2.0; CI 1.05 - 3.93; p = 0.035) and an early reperfusion was the sole predictor of functional independence (most recent mRS 0-2) (O.R: 4.1, 95% CI 1.62 - 10.53; adjusted p = 0.003). CONCLUSION Patients with a T.I. < 10 are significantly more likely to achieve early successful reperfusion after MT for the treatment of AIS.