Intra-arterial thrombectomy in elderly patients: assessment of arterial tortuosity in determining successful procedure

Abstract

Intra-arterial thrombectomy (IAT) has become the mainstay of treatment for ischemic stroke caused by large artery occlusion [1,2]. However, IAT in older patients should be carefully considered due to uncertain clinical outcomes despite the risk of procedure-related complications [3,4]. Vascular tortuosity and longer procedure time have been suggested as factors associated with Objective: Intra-arterial thrombectomy (IAT) is the mainstay of initial treatment for intracranial large-vessel occlusion. However, arterial tortuosity is associated with procedural failure and unfavorable outcomes in older patients. Methods: We reviewed patients with ischemic stroke (>75 years) treated with IAT and analyzed procedure-related complications and arterial tortuosity based on pre-procedural computed tomography angiography. Results: Of the 29 patients, 7 had distal internal carotid artery (ICA) occlusion, 18 had middle cerebral artery (MCA) occlusion, 3 had anterior cerebral artery and MCA occlusion, and one had distal ICA and MCA occlusion. Significant arterial tortuosity was observed in 9 patients (31.0%). The degree of recanalization, as assessed by the modified thrombolysis in cerebral infarction grade, did not differ according to significant arterial tortuosity (P=0.55). Post-procedural subarachnoid hemorrhage was observed in 17 of 29 patients (58.6%) and there was no significant association with significant arterial tortuosity. The puncture to recanalization time was not significantly different according to the presence of significant arterial tortuosity (51.6±22 minutes vs. 53±43.9 minutes; P=0.93). Additionally, the number of thrombus retrieval trials during the procedure did not show a significant relationship with arterial tortuosity (2.4±1.2 times vs. 2.6±2.5 times; P=0.86). Conclusion: IAT can be performed in patients aged >75 years. Arterial tortuosity was not significantly associated with successful recanalization or post-procedural complications. Therefore, whether to perform IAT in older patients should not be determined only by arterial tortuosity.