Neurology · 2 h ago
Cervical Curvature Associated With Recanalization Failure After Thrombectomy
A retrospective single-center cohort study of 160 patients with anterior large-vessel occlusion found that greater cervical vessel curvature was associated with lower recanalization success after mechanical thrombectomy. Curvature was not associated with intracranial access time; the authors propose it as a potential preprocedural risk-stratification measure.
- Higher cervical curvature was associated with recanalization failure.
- Recanalization was 75% in the highest-curvature tertile.
- Curvature was not associated with intracranial access time.
- The proposed threshold needs external validation.
Researchers retrospectively studied 160 patients with anterior large-vessel occlusion who underwent mechanical thrombectomy at one comprehensive stroke center between May 2019 and February 2021. They calculated cervical vessel curvature from three-dimensional centerlines on preprocedural CT angiography. Outcomes were successful recanalization, defined as a final modified Thrombolysis in Cerebral Infarction score of at least 2b, and time from puncture to first intracranial pass. Regression models adjusted for age, stroke severity, first-line device, and access route.
Successful recanalization occurred in 86% of patients overall. Rates were 91% in the lowest curvature tertile, 93% in the middle tertile, and 75% in the highest (P=0.017). Each unit increase in curvature was associated with higher adjusted odds of recanalization failure (odds ratio, 1.21; 95% CI, 1.02–1.43). A curvature threshold above 11.54 was associated with an adjusted odds ratio of 5.10 for failure (95% CI, 1.88–13.84). Curvature was not associated with intracranial access time.
The findings suggest routine CTA-derived curvature may help identify patients at increased risk of unsuccessful recanalization. However, this retrospective, single-center study establishes an association, not that changing device selection or procedural strategy based on curvature improves outcomes. The proposed threshold requires validation in other cohorts.
In practice
For patients undergoing mechanical thrombectomy for anterior large-vessel occlusion, greater cervical vessel curvature on preprocedural CTA was associated with lower recanalization success in this retrospective, single-center cohort of 160 patients. The association may support further evaluation of curvature as a risk-stratification measure, but the study did not test whether adapting device selection or procedural strategy improves outcomes. Its proposed threshold and predictive value require validation in larger, independent populations before informing practice.
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Stroke: Preprocedural Curvature Assessment Can Stratify Recanalization Risk Before Device Selection in Mechanical Thrombectomy ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.