Introduction: In the current era of acute stroke intervention (ASI), successful revascularization is paramount to reduce the ischemic burden of large vessel occlusion and increase the likelihood of improved functional outcomes. To identify factors associated with increased risk of failed revascularization in patients undergoing ASI with stent-retrievers for large vessel occlusion, cases were reviewed for anatomical factors limiting successful balloon-guide access.
Methods: A retrospective analysis of patients undergoing ASI for acute large vessel occlusion during a 2-year period was conducted. Individual vascular variations including unfavorable arch configuration, bovine configuration in left-sided lesions, and tortuous carotid anatomy were correlated with revascularization (TICI 2b or 3) and a scoring system was devised to help predict problems with access and revascularization. Scores on the scale ranged from 0-3. One point was given to arch type III, bovine arch in left-sided interventions, and acute CCA bends (>90%). Comparisons were made with Fisher's exact test.
Results: A total of 33 patients were included. Mean age was 70 years (range 26-95 years). Scores of 0 were associated with 100% successful access and revascularization, scores of 1 had 66% successful access and revascularization, and scores of 2 or more had 57% successful access and 42% successful revascularization. Higher scores (2 or more) had a statistically significant increased failure rate (p=0.03 for access, p=0.01 for revascularization). Patients older than 80 were more likely to pose access challenges (scores of 2 or more) and failed revascularization compared to younger patients (41% versus 14%, p=0.06).
Conclusions: Vascular anatomy and age play an important role in the likelihood of successful lesion access and revascularization after large vessel occlusion. We propose a scoring system that can help clinicians identify potential poor candidates for conventional ASI and may require novel access strategies.
Patient Care: Vascular anatomy and age play an important role in the likelihood of successful lesion access and revascularization after large vessel occlusion. We propose a scoring system that can help clinicians identify potential poor candidates for conventional ASI and may require novel access strategies.
Learning Objectives: After this session, participants will better understand anatomical factors that limit ability to treat acute ischemic stroke due to technical factors.