Unfavorable Vascular Anatomy Is Associated with Increased Revascularization Time and Worse Outcome in Anterior Circulation Thrombectomy

• Published in: World neurosurgery Vol. 120; pp. e976 - e983
• Main Authors: Snelling, Brian M., Sur, Samir, Shah, Sumedh S., Chen, Stephanie, Menaker, Simon A., McCarthy, David J., Yavagal, Dileep R., Peterson, Eric C., Starke, Robert M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2018
• Subjects: Adult; Aged; Aged, 80 and over; Arteries - diagnostic imaging; Arteries - pathology; Arteries - surgery; Biological Variation, Individual; Bovine; Brain Ischemia - diagnostic imaging; Brain Ischemia - pathology; Brain Ischemia - surgery; Endovascular Procedures; Female; Humans; Ischemia; Large vessel; Male; Middle Aged; Occlusion; Outcomes research; Prospective Studies; Stroke; Stroke - diagnostic imaging; Stroke - pathology; Stroke - surgery; Thrombectomy; Time Factors; Tortuosity; Treatment Outcome; Occlusion; CCA; Stroke; OR; Bovine; ASPECTS; LVO; Tortuosity; CI; ICA; Outcomes research; mRS; CT; Thrombectomy; Ischemia; Large vessel; B.A.D; TICI
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.08.207

Reperfusion time influences patient outcome in mechanical thrombectomy for large vessel occlusion. We analyzed anatomic features that could be used to make preoperative and intraoperative decisions to minimize revascularization time. We reviewed a prospectively maintained database for patients with stroke evaluated from February 2015 to July 2016. Patients received a score based on bovine arch, aortic arch, and internal carotid artery dolichoarteriopathy (B.A.D. score), which we correlated with procedural times and outcomes. Univariate analysis was performed to identify predictors of procedural times, revascularization, complications, and outcome. Relevant variables were assessed via multivariate regression. We identified 61 patients (31 men) who underwent transfemoral thrombectomy. Mean puncture to reperfusion time was 46 minutes. Age >75 years (odds ratio [OR] = 3.98; 95% confidence interval [CI], 1.17–13.54; P = 0.027) and high B.A.D. score (OR = 2.55; 95% CI, 1.17–5.57; P = 0.019) were significant predictors of puncture to reperfusion time >40 minutes. Mean puncture to first-pass time was 24 ± 14.2 minutes. Age >65 years (OR = 4.68; 95% CI, 1.07–20.55; P = 0.041) and high B.A.D. score (OR = 2.84; 95% CI, 1.18–6.85; P = 0.020) were independently predictive of time to first pass >20 minutes. Lower scores predicted higher Thrombolysis In Cerebral Infarction score (OR = 0.07; 95% CI, 0.01–0.81; P = 0.033). Higher scores predicted hemorrhagic transformation (OR = 4.8; 95% CI, 1.19–12.29; P = 0.024) and modified Rankin Scale score >4 (OR = 3.0; 95% CI, 1.15–7.92; P = 0.025) after thrombectomy. Bovine variation, aortic arch type, and internal carotid artery dolichoarteriopathy are associated with increased revascularization time and poor outcomes in thrombectomy. We developed the B.A.D. score to predict reperfusion time and outcomes, demonstrating need for preoperative anatomic evaluation to guide treatment. •Vascular anatomy correlates with reperfusion and outcome in stroke thrombectomy.•We developed an anatomic score to predict reperfusion time and patient outcome (B.A.D. score).•B.A.D. refers to bovine arch, aortic arch type, and ICA dolichoarteriopathy.•Higher B.A.D. scores are predictive of longer reperfusion time and worse outcome.•Preoperative anatomic evaluation is warranted to guide treatment.