Impact of intracranial vessel tortuosity on mechanical thrombectomy outcomes in acute ischemic stroke: A systematic review

Background

Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality. Mechanical thrombectomy (MT) is the standard of care for large vessel occlusions (LVO), but anatomical factors like intracranial vessel tortuosity can influence procedural success. This systematic review evaluates the impact of intracranial vessel tortuosity on outcomes of MT in AIS patients, focusing on recanalization success, hemorrhagic complications, and functional recovery.

Design/methods

We conducted a systematic review following PRISMA guidelines across PubMed, EMBASE, Scopus, and Web of Science until August 2024. Studies were included if they demonstrate the effect of intracranial vessel tortuosity on MT outcomes.

Results

Of the 321 identified studies, 8 met the inclusion criteria, comprising 1942 patients. All studies focused exclusively on the anterior circulation. Studies evaluating the impact of intracranial vessel tortuosity on recanalization success have shown that higher tortuosity compared to no/low tortuosity is associated with an increased number of thrombectomy passes (mean: 2.1 vs. 1.6) and lower overall success rates, with an average final Thrombolysis in Cerebral Infarction (TICI) score > 2b achieved in (63 % vs 76 %) of cases. First-pass effect (FPE) success was lower in tortuous vessels (average 34 % vs 59 %), with odds ratios for unsuccessful FPE ranging from 0.20 to 0.95. Tortuosity and functional recovery were inconsistently linked to hemorrhagic complications.

Conclusions

Intracranial vessel tortuosity reduces recanalization success and increases procedural challenges. Its impact on complications and long-term outcomes remains unclear, highlighting the need for further research.