Abstract 003: Intracranial Access Segment Diameter and Occlusion Site Impact On First Pass Success And Hemorrhagic Transformation

• Published in: Stroke: vascular and interventional neurology 2024-11, Vol.4 (S1)
• Main Authors: Canals, P, Sastre, B, García-Tornel, A, Ribo, M
• Format: Article
• Language: English
• Subjects: Hemorrhage
• ISSN: 2694-5746; 2694-5746
• DOI: 10.1161/SVIN.04.suppl_1.003

IntroductionChallenging anatomy and tortuous vessels have been associated with poor outcomes in stroke patients undergoing endovascular therapy (EVT), especially in distal vessel occlusions where its safety remains controversial. This study aims to examine the relationship between intracranial anatomical vascular features and EVT outcomes.MethodsA pre‐existing proprietary machine‐learning‐based software was used to automatically extract the vascular centerline segment from the common carotid artery bifurcation to the occlusion site on admission CTA. Manual intervention was limited to confirm thrombus location. For each vascular segment, the tortuosity index (TI), the mean diameter of the entire segment (mean diameter) and the last 5 mm (diameter at occlusion) were computed. Statistical differences were assessed across groups defined by occlusion location. We also determined the association of anatomical features with procedural outcomes: first pass effect (FPE, mTICI2c at first pass), final successful (mTICI2b) or excellent recanalization (mTICI2c), and hemorrhagic transformation.ResultsA sample of 437 cases presenting an intracranial vessel occlusion in the anterior circulation treated with EVT between 2017 and 2022 (41% women, median age 81 IQR 70‐88 years) was analyzed. Patients with distal occlusions (distal MCA‐M2, 65 cases, 15%) presented smaller diameter at occlusion site (distal: 2.42±0.74mm, proximal: 2.78±0.82mm; p