Semi-automated tortuosity measurements confirm generalizability of IMPERATIVE trial results to real-world patients with acute ischemic stroke undergoing thrombectomy
Year: 2025
Type: article
Abstract: Background Criticism 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. Methods Using 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). Results Of 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%, p = .038). Conclusions Imperative trial patients treated with aspiration thrombectomy had similar vascular tortuosity characteristics compared to patients treated with thrombectomy in a real-world clinical setting. This confirms the generalizability of Imperative Trial findings to real-world clinical practice.
Source: Interventional Neuroradiology
Authors: Maxim Mokin, William J Mack, Raul G Nogueira, Jonathan A Grossberg, Shahram Majidi, Dana Tomalty, Jan Vargas, Brett L Cucchiara, Kenneth V Snyder, Justin R Mascitelli, Victoria Parada, Hakeem J Shakir, David Rosenbaum-Halevi, Nima Aghaebrahim, Dan Hoit, Benjamin Yim, Matthew S Tenser, Alhamza R Al-Bayati, James M Milburn, Shahid M Nimjee, Neil Haranhalli, Michael Nahhas, Darryn I Shaff, Kennith F Layton, Narlin B Beaty, Robert M Starke, Harris Hawk, Diogo C Haussen, Aqueel Pabaney, Christopher P Kellner, Reade A De Leacy
Institutions: University of South Florida, University of Southern California, Keck Hospital of USC, UPMC Health System, University of Pittsburgh Medical Center, Emory University, Icahn School of Medicine at Mount Sinai, Huntsville Hospital, Prisma Health, University of Pennsylvania, University at Buffalo, State University of New York, The University of Texas at San Antonio Health Science Center, Valley Baptist Medical Center, University of Oklahoma Health Sciences Center, Munson Medical Center, Baptist Medical Center Jacksonville, University of Tennessee Health Science Center, John Muir Health, John Muir Medical Center, Ochsner Health System, Ochsner Medical Center, The Ohio State University, Albert Einstein College of Medicine, Montefiore Medical Center, The University of Texas Health Science Center at Houston, Lehigh Valley Hospital, Baylor University Medical Center, Florida State University, Tallahassee Memorial HealthCare, University of Miami Health System, Erlanger Health System
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Award: G186995139
OpenAlex ID: W4412516554