ArticleEuropean stroke journal2023
Impact of vessel tortuosity and radiological thrombus characteristics on the choice of first-line thrombectomy strategy: Results from the ESCAPE-NA1 trial.
Article in European stroke journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 20 citations in OpenAlex.
- Efficacy and safety of combined stent retriever and contact aspiration vs. stent retriever alone on revascularization in patients with acute ischemic stroke: a systematic review and meta-analysis.Frontiers in neurology · 2024Pooled it
- Is endovascular treatment still good for acute ischemic stroke in the elderly? A meta-analysis of observational studies in the last decade.Frontiers in neuroscience · 2023Pooled it
- Cerebrovascular CTA radiomics for objective collateral grading in acute ischemic stroke.European radiology experimental · 2026Article
- Prognostic value of intracranial vascular tortuosity in thrombectomy for distal vessel occlusion.European stroke journal · 2026Article
- Prognostic value of intracranial vascular tortuosity in thrombectomy for distal vessel occlusion.European stroke journal · 2025Article
- Thrombus perviousness in acute ischemic stroke: a scoping review of methodology, predictive value, and future perspectives.Neuroradiology · 2025Article
- Prognostic value of recanalization attempts in endovascular therapy for M2 segment middle cerebral artery occlusions.International journal of stroke : official journal of the International Stroke Society · 2024Observational
- Value of Automatically Derived Full Thrombus Characteristics: An Explorative Study of Their Associations with Outcomes in Ischemic Stroke Patients.Journal of clinical medicine · 2024Article
- Evaluation of partial resheathing of EmboTrap III using the microcatheter (PREMIER) technique for fibrin-rich hard clots in anFrontiers in neurology · 2024Article
- Investigation of stent retriever removal forces in an experimental model of acute ischemic stroke.Frontiers in neurology · 2024Article
- Emerging Concept of Intracranial Arterial Diseases: The Role of High Resolution Vessel Wall MRI.Journal of stroke · 2024Review
Corrections and comments
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Authors and funding
18 authors at 6 institutions in 6 countries.
Funding
Abstract
introductionDespite improvements in device technology, only one-third of stroke patients undergoing endovascular thrombectomy (EVT) achieve first-pass effect (FPE). We investigated the effect of arterial tortuosity and thrombus characteristics on the relationship between first-line EVT strategy and angiographic outcomes. PATIENTS AND
methodsPatients with thin-slice baseline CT-angiography from the ESCAPE-NA1 trial (Efficacy and safety of nerinetide for the treatment of acute ischemic stroke) were included. Tortuosity was estimated using the tortuosity index extracted from catheter pathway, and radiological thrombus characteristics were length, non-contrast density, perviousness and hyperdense artery sign. We assessed the association of first-line EVT strategy (stent-retriever [SR] versus contact aspiration [CA] versus combined SR+CA) with FPE (eTICI score 2c/3 after one pass), final eTICI 2b/3, number of passes and procedure duration using multivariable regression. Interaction of tortuosity and thrombus characteristics with first-line technique were assessed using interaction terms.
resultsAmong 520 included patients, SR as a first-line modality was used in 165 (31.7%) patients, CA in 132 (25.4%), and combined SR+CA in 223 (42.9%). FPE was observed in 166 patients (31.9%). First-line strategy was not associated with FPE. Tortuosity had a significant effect on FPE only in the CA group (aOR = 0.90 [95% CI 0.83-0.98]) compared with stent-retrievers and combined first-line approach (p interaction = 0.03). There was an interaction between thrombus length and first-line strategy for number of passes (p interaction = 0.04). Longer thrombi were associated with higher number of passes only in the CA group (acOR 1.03 [95% CI 1.00-1.06]).
conclusionOur study suggests that vessel tortuosity and longer thrombi may negatively affect the performance of first-line contact aspiration catheters in acute stroke patients undergoing EVT.
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