The impact of extracranial İCA tortuosity on the outcomes of mechanical thrombectomy treatment in patient with acute ischemic stroke

Objective: We aimed to investigate the effect of extracranial ICA tortuosity on the clinical and technical results of mechanical thrombectomy in patients with acute ischaemic stroke due to MCA M1 occlusion. Materials and Methods: We included 181 patients with ischaemic stroke due to MCA M1 occlusion treated with mechanical thrombectomy. The DSA images of the patients during the procedure were retrospectively analyzed, and four groups were formed by evaluating the cavernous-extracranial ICA tortuosity, and extracranial ICA tortuosity indices were calculated. Demographic and clinical data of the patients were obtained from the information management systems of our hospital, and ASPECT scores and hemorrhagic transformation development were evaluated on the images obtained from the PACS system of our hospital. Results: In the group with tortuous cavernous and extracranial ICA (group 4), eTICI ≥ 2c reperfusion rates at first-pass and the end of the procedure were significantly lower compared to the group with nontortious ICA (group 1). However, no significant difference was found between the groups regarding eTICI ≥ 2b reperfusion rates, development of hemorrhagic transformation and complications, and functional independence status at 90th days. Procedure duration and number of passes were significantly higher in group 4 compared to group 1. Extracranial ICA TI values were significantly higher in women and patients with hypertension. There was a significant positive correlation between extracranial ICA TI values and age, procedure time, and number of passes. Extracranial ICA TI values were significantly lower in patients with first-pass eTICI ≥ 2b and eTICI ≥ 2c reperfusion. Conclusion: We found that extracranial ICA tortuosity alone did not significantly affect mechanical thrombectomy's clinical and technical success. The combined tortuosity of the cavernous and extracranial ICA negatively affects the first-pass and final eTICI ≥ 2c reperfusion status and procedure time.