{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T05:16:06Z","timestamp":1781327766128,"version":"3.54.1"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Although the relationship between cervical carotid tortuosity and cardiovascular risk in patients with Loeys-Dietz syndrome has been studied, it is unclear whether cervical carotid tortuosity influences the risk of neurovascular events.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>This is a single-institution retrospective cohort study. Cervical carotid tortuosity and morphology were assessed in patients with Loeys-Dietz syndrome who underwent baseline computed tomography\/magnetic resonance imaging of the cervical and cerebral arteries from 2010 to 2022. The primary end point was a composite of adverse neurovascular events (multiple vessel cervical artery dissection, ischemic stroke, intracerebral hemorrhage, and any neurovascular intervention) at 5- and 10-year follow-ups. Independent risk factors were identified using univariate and multivariate logistic regression analyses. Single-variable predictors of 5- and 10-year outcomes were analyzed via receiver operating curve analyses. Cutoff values were determined per the Youden J index. Stratification analyses were performed for ages &lt;60 and \u226560 years.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Of 105 eligible participants, 63 were included (mean age, 40\u00b117 years; 52% female). During a mean follow-up of 8.7\u00b14.1 years, 23 (37%) developed an adverse neurovascular event. Five-year follow-up was achieved in 86% and 10-year follow-up in 48%. Carotid total absolute curvature (TAC;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.008), coiling morphology (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.012), and\n              <jats:italic toggle=\"yes\">TGFBR1\/2<\/jats:italic>\n              genetic variant (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.037) were independently associated with 5-year events. Stratification analyses revealed that the age group &lt;60 years was more vulnerable to high TAC (unadjusted odds ratio, 7.2 [95% CI, 2.0\u201325.4];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.002). Baseline TAC was the only independent predictor of adverse events at 5 years (area under the curve, 0.84;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001) and 10 years (area under the curve, 0.75;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.007) in this age group. An optimal threshold for predicting neurovascular events was TAC \u226516.5. None were predictive in the age group \u226560 years.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Cervical carotid tortuosity is associated with a long-term increased risk of neurovascular events in Loeys-Dietz syndrome. Angiographic findings of high-risk features such as increased TAC and coiling morphology may help to identify neurovascular vulnerability noninvasively at an early stage.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.124.048028","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T05:00:23Z","timestamp":1739163623000},"page":"667-677","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Three-Dimensional Curvature of the Cervical Carotid Artery Predicts Long-Term Neurovascular Risk in Loeys-Dietz Syndrome"],"prefix":"10.1161","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8961-0125","authenticated-orcid":true,"given":"Jin Vivian","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery (J.V.L., A.L.H., R.G.D., J.W.O.), Washington University School of Medicine, St. Louis, MO."},{"name":"Department of Biomedical Engineering, Washington University in St. Louis, MO (J.V.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8625-4698","authenticated-orcid":true,"given":"Anna L.","family":"Huguenard","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery (J.V.L., A.L.H., R.G.D., J.W.O.), Washington University School of Medicine, St. Louis, MO."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1859-310X","authenticated-orcid":true,"given":"Alan C.","family":"Braverman","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Department of Medicine (A.C.B.), Washington University School of Medicine, St. Louis, MO."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9181-6413","authenticated-orcid":true,"given":"Ralph G.","family":"Dacey","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery (J.V.L., A.L.H., R.G.D., J.W.O.), Washington University School of Medicine, St. Louis, MO."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4308-9669","authenticated-orcid":true,"given":"Joshua W.","family":"Osbun","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery (J.V.L., A.L.H., R.G.D., J.W.O.), Washington University School of Medicine, St. Louis, MO."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A1651"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCGENETICS.116.001485"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/ng.744"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/jmedgenet-2011-100382"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.990549"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/RCT.0000000000000764"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.029518"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.035171"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.95.10.2351"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.25.6.1201"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1992.76.1.0062"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.15.1.7"},{"key":"e_1_3_3_14_2","first-page":"68","article-title":"Carotid artery tortuosity, kinking, coiling: stroke risk factor, marker, or curiosity?","volume":"105","author":"Togay-Isikay CA","year":"2005","unstructured":"Togay-Isikay CA, Kim J, Betterman K, Andrews C, Meads D, Tesh P, Tegeler C, Oztuna D. 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