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KMID : 1150320210170020038
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Journal of Korean Society of Geriatric Neurosurgery
2021 Volume.17 No. 2 p.38 ~ p.43
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Intra-arterial thrombectomy in elderly patients: assessment of arterial tortuosity in determining successful procedure
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Kye Su-Min
Ahn Jun-Hyoung
Chang In-Bok
Song Joon-Ho
Kim Ji-Hee
Lee Heui-Seung
Oh Jae-Keun
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Abstract
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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.
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KEYWORD
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Elderly patients, Carotid arteries, Stroke, Thrombectomy, Tortuosity
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