{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:06:36Z","timestamp":1791389196153,"version":"4.3.3"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI21\/01967"],"award-info":[{"award-number":["PI21\/01967"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010552","name":"Departament de Salut, Generalitat de Catalunya","doi-asserted-by":"publisher","award":["SLT017\/20\/000180"],"award-info":[{"award-number":["SLT017\/20\/000180"]}],"id":[{"id":"10.13039\/501100010552","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Neutral results from trials assessing mechanical thrombectomy (MT) for medium\/distal vessel occlusions (MDVO) suggest the need for better selection criteria in these patients. Tortuous vascular anatomies may negatively influence MT efficacy and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>Consecutive patients with middle cerebral artery (MCA)-MDVO (M2\/M3) who underwent MT at our center between January 2017\u2009and\u2009September 2024 were included. Baseline CTAs were semi-automatically analyzed using an in-house vascular analysis framework. The internal carotid artery (ICA) tortuosity index (TI) and anatomical features of the MCA were extracted. Logistic regression adjusted for intravenous thrombolysis administration and onset-to-puncture time evaluated associations of anatomical features with treatment efficacy and safety endpoints. Primary endpoints were complete recanalization (final eTICI 2c\/3) and symptomatic intracranial hemorrhage (sICH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>213 patients (81\u2009years IQR 72\u201387, 51.2% female) were included. MCA bending length (aOR 0.48 [95%CI 0.27\u20130.86], p\u2009=\u20090.013), MCA-TI (aOR 0.77 [0.60\u20130.98], p\u2009=\u20090.032) and ICA-TI (aOR 0.59 [0.36\u20130.96], p\u2009=\u20090.034) were associated with lower probability of complete recanalization. ICA-TI (aOR 0.51 [0.31\u20130.84], p\u2009=\u20090.008) and mean MCA diameter (aOR 0.34 [0.13\u20130.90], p\u2009=\u20090.030) correlated with decreased odds of first-pass recanalization. Large mean MCA diameter was associated with lower likelihood of excellent functional outcome (aOR 0.30 [0.09\u20130.96], p\u2009=\u20090.042). Regarding safety endpoints, larger diameter at occlusion was associated with sICH (aOR 4.04 [1.03\u201315.87], p\u2009=\u20090.046), while MCA bending length (aOR 2.47 [1.24\u20134.92], p\u2009=\u20090.010) was linked to subarachnoid hemorrhage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Automatic evaluation of anatomical vascular features may predict safety and efficacy of MT in stroke patients with MCA-MDVO. The value of these features as inclusion criteria for future MCA-MDVO clinical trials should be explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Intracranial vascular tortuosity is associated to poor thrombectomy outcomes in patients with MDVO.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/esj\/23969873251350124","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T11:02:01Z","timestamp":1768906921000},"source":"Crossref","is-referenced-by-count":2,"title":["Prognostic value of intracranial vascular tortuosity in thrombectomy for distal vessel occlusion"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0192-3272","authenticated-orcid":false,"given":"Pere","family":"Canals","sequence":"first","affiliation":[{"name":"Stroke Unit , Neurology, Hospital Vall d\u2019Hebron, Barcelona ,","place":["Spain"]},{"name":"Department of Radiology , Stanford University, Stanford, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3633-3002","authenticated-orcid":false,"given":"Alvaro","family":"Garc\u00eda-Tornel","sequence":"additional","affiliation":[{"name":"Stroke Unit , Neurology, Hospital Vall d\u2019Hebron, Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio Maria","family":"Fiore","sequence":"additional","affiliation":[{"name":"Stroke Unit , Neurology, Hospital Vall d\u2019Hebron, Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7953-3795","authenticated-orcid":false,"given":"Marc","family":"Rodrigo-Gisbert","sequence":"additional","affiliation":[{"name":"Stroke Unit , Neurology, Hospital Vall d\u2019Hebron, Barcelona ,","place":["Spain"]},{"name":"Departament de Medicina , Universitat Aut\u00f2noma de Barcelona, Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blanca","family":"Sastre","sequence":"additional","affiliation":[{"name":"Stroke Unit , Neurology, Hospital Vall d\u2019Hebron, Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Mayol","sequence":"additional","affiliation":[{"name":"Stroke Unit , Neurology, Hospital Vall d\u2019Hebron, Barcelona ,","place":["Spain"]},{"name":"Departament de Medicina , Universitat Aut\u00f2noma de Barcelona, Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Ribo","sequence":"additional","affiliation":[{"name":"Stroke Unit , Neurology, Hospital Vall d\u2019Hebron, Barcelona ,","place":["Spain"]},{"name":"Departament de Medicina , Universitat Aut\u00f2noma de Barcelona, Barcelona 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