Impact of cavernous internal carotid artery tortuosity on technical and clinical outcomes in mechanical thrombectomy for acute ischemic stroke: a single-center retrospective study.
Z, U.K., HB, A., Ö, A., & AÖ, Ö. (2026). Impact of cavernous internal carotid artery tortuosity on technical and clinical outcomes in mechanical thrombectomy for acute ischemic stroke: a single-center retrospective study.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1867423
Z UK, HB A, Ö A, AÖ Ö. Impact of cavernous internal carotid artery tortuosity on technical and clinical outcomes in mechanical thrombectomy for acute ischemic stroke: a single-center retrospective study.. Frontiers in neurology. 2026; doi: 10.3389/fneur.2026.1867423
Z UK, HB A, Ö A, et al. Impact of cavernous internal carotid artery tortuosity on technical and clinical outcomes in mechanical thrombectomy for acute ischemic stroke: a single-center retrospective study.[J]. Frontiers in neurology. 2026. DOI: 10.3389/fneur.2026.1867423.
@article{z2026,
author = {Uysal Kocabaş Z and Adıyaman HB and Aykaç Ö and Özdemir AÖ},
title = {Impact of cavernous internal carotid artery tortuosity on technical and clinical outcomes in mechanical thrombectomy for acute ischemic stroke: a single-center retrospective study.},
journal = {Frontiers in neurology},
year = {2026},
doi = {10.3389/fneur.2026.1867423},
note = {PMID: 42621496},
}
TY - JOUR AU - Uysal Kocabaş Z AU - Adıyaman HB AU - Aykaç Ö AU - Özdemir AÖ TI - Impact of cavernous internal carotid artery tortuosity on technical and clinical outcomes in mechanical thrombectomy for acute ischemic stroke: a single-center retrospective study. T2 - Frontiers in neurology PY - 2026 DO - 10.3389/fneur.2026.1867423 AN - PMID:42621496 ER -
BACKGROUND AND PURPOSE: Cavernous internal carotid artery (ICA) tortuosity may hinder catheter navigation during mechanical thrombectomy (MT) for acute ischemic stroke (AIS). However, its impact on procedural and clinical outcomes remains unclear. This study evaluated the association between cavernous ICA tortuosity, classified by the Lin grading system, and outcomes in patients undergoing MT for middle cerebral artery (MCA) occlusion. METHODS: In this single-center retrospective study, 425 patients with MCA occlusion treated with MT were included. Patients were categorized as tortuous (n = 205; Lin III-IV) or non-tortuous (n = 220; Lin I-II) based on lateral angiographic assessment. The primary outcome was successful recanalization within 60 min (puncture-to-recanalization). Secondary outcomes included first-pass success, final eTICI (2c-3), intracranial hemorrhage, new territory embolism, and functional outcomes (modified Rankin Scale [mRS]) at discharge and 90 days. Multivariate logistic regression identified predictors of first-pass success. RESULTS: Tortuous anatomy was associated with lower first-pass success (43.9% vs. 54.1%; p = 0.036), fewer recanalizations within 60 min (47.3% vs. 57.3%; p = 0.040), and more procedural attempts (median 3 vs. 1; p = 0.025). Intracranial hemorrhage (35.6% vs. 20.5%; p < 0.001) and new territory embolism (5.4% vs. 1.8%; p = 0.048) were more frequent in the tortuous group. IA-tPA use was higher in tortuous patients (21.0% vs. 11.4%; p = 0.007). Good functional outcome (mRS 0-2) at discharge was significantly lower in the tortuous group (38.5% vs. 55.0%; p = 0.001). Cavernous tortuosity independently reduced first-pass success (OR = 0.643; 95%CI: 0.431-0.958; p = 0.030), while ASPECTS ≥6 (OR = 1.566; p = 0.040) and aspiration technique (OR = 3.682; p < 0.001) were positive predictors. CONCLUSION: Cavernous ICA tortuosity is an independent predictor of reduced first-pass success and worse early outcomes in MT. Aspiration may be a more effective strategy in this subgroup, supporting the importance of pre-procedural anatomical assessment.