Semi-automated tortuosity measurements confirm generalizability of IMPERATIVE trial results to real-world patients with acute ischemic stroke undergoing thrombectomy.
Publication/Presentation Date
7-21-2025
Abstract
BackgroundCriticism of clinical trials of endovascular therapy of acute ischemic stroke due to large vessel occlusion includes their lack of generalizability. We aimed to evaluate the impact of vessel tortuosity on the outcomes of large-bore and super-bore aspiration catheters in the Imperative Trial and to compare trial's selection of patients to a real-world setting.MethodsUsing baseline craniocervical angiography, we performed semi-automated analysis of various tortuosity characteristics. Comparison of tortuosity characteristics was made to a previously published cohort of 100 consecutive patients treated with thrombectomy (real-world cohort).ResultsOf the 249 Imperative Trial patients with anterior circulation strokes, 187 (89%) had complete tortuosity assessments from the aortic arch to the occlusion site. Tortuosity indexes for the common carotid, extracranial and intracranial internal carotid artery segments were similar for both cohorts (right side 0.18 ± 0.10, 0.17 ± 0.09, 0.45 ± 0.09 vs. 0.20 ± 0.09, 0.17 ± 0.09, 0.45 ± 0.09; left side: 0.12 ± 0.08, 0.19 ± 0.09, 0.44 ± 0.07 vs. 0.15 ± 0.08, 0.18 ± 0.08, 0.47 ± 0.07 in the Imperative Trial and in the real-world cohort, respectively). The proportion of patients with type 3 aortic arches was higher in the Imperative Trial than the real-word cohort (26% vs. 15%,
First Page
15910199251359089
Last Page
15910199251359089
ISSN
2385-2011
Published In/Presented At
Mokin, M., Mack, W. J., Nogueira, R. G., Grossberg, J. A., Majidi, S., Tomalty, D., Vargas, J., Cucchiara, B. L., Snyder, K. V., Mascitelli, J. R., Parada, V., Shakir, H. J., Rosenbaum-Halevi, D., Aghaebrahim, N., Hoit, D., Yim, B., Tenser, M. S., Al-Bayati, A. R., Milburn, J. M., Nimjee, S. M., … De Leacy, R. A. (2025). Semi-automated tortuosity measurements confirm generalizability of IMPERATIVE trial results to real-world patients with acute ischemic stroke undergoing thrombectomy. Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences, 15910199251359089. Advance online publication. https://doi.org/10.1177/15910199251359089
Disciplines
Diagnosis | Medicine and Health Sciences | Other Analytical, Diagnostic and Therapeutic Techniques and Equipment | Radiology
PubMedID
40686305
Department(s)
Department of Radiology and Diagnostic Medical Imaging
Document Type
Article