Assessment of thrombectomy procedure difficulty by neurointerventionalists based on vessel geometry parameters from carotid artery 3D reconstructions

Mohammed Salman Shazeeb; Viraj Moholkar; Robert M King; Srinivasan Vedantham; Zeynep Vardar; Afif Kraitem; Clifford Lindsay; Vania Anagnostakou; Jasmeet Singh; Francesco Massari; Katyucia de Macedo Rodrigues; Varun Naragum; Ajit S Puri; Sarena Carniato; Matthew J Gounis; Anna Luisa Kühn

doi:10.1016/j.jocn.2023.05.014

Assessment of thrombectomy procedure difficulty by neurointerventionalists based on vessel geometry parameters from carotid artery 3D reconstructions

J Clin Neurosci. 2023 Jul:113:121-125. doi: 10.1016/j.jocn.2023.05.014. Epub 2023 May 30.

Authors

Mohammed Salman Shazeeb¹, Viraj Moholkar², Robert M King³, Srinivasan Vedantham⁴, Zeynep Vardar¹, Afif Kraitem³, Clifford Lindsay², Vania Anagnostakou³, Jasmeet Singh⁵, Francesco Massari⁵, Katyucia de Macedo Rodrigues⁶, Varun Naragum⁵, Ajit S Puri⁷, Sarena Carniato⁸, Matthew J Gounis⁹, Anna Luisa Kühn¹⁰

Affiliations

¹ Image Processing & Analysis Core (iPAC), Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA; New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
² Image Processing & Analysis Core (iPAC), Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
³ New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁴ Department of Medical Imaging, University of Arizona, AZ, USA.
⁵ Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁶ Greensboro Radiology, Greensboro, NC, USA.
⁷ New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA; Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁸ Stryker Corporation, Kalamazoo, MI, USA.
⁹ Image Processing & Analysis Core (iPAC), Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA; New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA. Electronic address: matthew.gounis@umassmed.edu.
¹⁰ Image Processing & Analysis Core (iPAC), Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA; Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA.

PMID: 37262981
DOI: 10.1016/j.jocn.2023.05.014

Abstract

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.

Keywords: Acute ischemic stroke; Rater assessment; Thrombectomy; Tortuosity; Vessel geometry.

MeSH terms

Carotid Artery, Internal / diagnostic imaging
Carotid Artery, Internal / surgery
Endovascular Procedures* / methods
Humans
Imaging, Three-Dimensional
Ischemic Stroke*
Retrospective Studies
Stroke* / diagnostic imaging
Stroke* / surgery
Thrombectomy / methods
Treatment Outcome