# Impact of Carotid Artery Tortuosity on Technical Aspects of Endovascular Thrombectomy in a Newly Established Thrombectomy-Capable Stroke Center

## TL;DR

This study examines how carotid artery tortuosity affects endovascular thrombectomy procedures and finds that tortuous arteries are linked to older age, hypertension, and longer procedure times.

## Contribution

The study introduces a new analysis of carotid artery tortuosity's impact on thrombectomy procedures in a newly established stroke center.

## Key findings

- Tortuous carotid arteries were associated with longer time from arterial puncture to first pass during thrombectomy.
- Patients with hypertension had higher tortuosity index values.
- Nontortuous carotid arteries were found in significantly younger patients.

## Abstract

Background/Objectives: Blood vessel tortuosity can complicate endovascular procedures such as endovascular thrombectomy in acute ischemic stroke. This study aimed to assess the morphometric characteristics of carotid arteries and investigate the association between the tortuosity of the carotid arteries and the technical aspects of endovascular thrombectomy, patient demographics and clinical characteristics, and treatment outcome. Methods: This retrospective study included 84 patients with ischemic stroke treated by endovascular thrombectomy at the newly established thrombectomy-capable stroke center. The following data were collected from prethrombectomy computed tomography angiography: aortic arch type, type of carotid artery tortuosity, and tortuosity index (TI). The technical aspects of the procedure, as well as patient demographics, were collected from the radiological information system. Results: Time from arterial puncture to the first pass was significantly shorter in patients with a nontortuous carotid artery compared to a tortuous one (p = 0.006). There were no significant differences in the number of passes, total duration of the procedure, and the difference in National Institutes of Health Stroke Scale (NIHSS) score before and after the procedure regarding the form of tortuosity. Patients with hypertension had significantly higher tortuosity index values compared to those without hypertension (p = 0.008), and patients with a nontortuous carotid tree were significantly younger compared to those with all forms of tortuosity (p = 0.003). Conclusions: The majority of patients had tortuous carotid arteries, which were associated with older age and hypertension. A high index of tortuosity was associated with a longer time from arterial puncture to the first pass, but not to the treatment outcome. Preprocedural recognition of carotid artery tortuosity may aid in endovascular thrombectomy procedural planning.