{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:39:53Z","timestamp":1793147993561,"version":"4.5.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"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":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["European Stroke Journal"],"abstract":"<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>\n                      213 patients (81\u2009years IQR 72\u201387, 51.2% female) were included. MCA bending length (aOR 0.48 [95%CI 0.27\u20130.86],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013), MCA-TI (aOR 0.77 [0.60\u20130.98],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032) and ICA-TI (aOR 0.59 [0.36\u20130.96],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034) were associated with lower probability of complete recanalization. ICA-TI (aOR 0.51 [0.31\u20130.84],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008) and mean MCA diameter (aOR 0.34 [0.13\u20130.90],\n                      <jats:italic>p<\/jats:italic>\n                      \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],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.042). Regarding safety endpoints, larger diameter at occlusion was associated with sICH (aOR 4.04 [1.03\u201315.87],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.046), while MCA bending length (aOR 2.47 [1.24\u20134.92],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010) was linked to subarachnoid hemorrhage.\n                    <\/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":"10.1177\/23969873251350124","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T01:55:33Z","timestamp":1750989333000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Prognostic value of intracranial vascular tortuosity in thrombectomy for distal vessel occlusion"],"prefix":"10.1093","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, Spain"},{"name":"Department of Radiology, Stanford University, Stanford, CA, 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, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio Maria","family":"Fiore","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology, Hospital Vall d\u2019Hebron, Barcelona, 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, Spain"},{"name":"Departament de Medicina, Universitat Aut\u00f2noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blanca","family":"Sastre","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology, Hospital Vall d\u2019Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Mayol","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology, Hospital Vall d\u2019Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9828-0594","authenticated-orcid":false,"given":"Jes\u00fas David","family":"Gonz\u00e1lez Riveros","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology, Hospital Vall d\u2019Hebron, Barcelona, Spain"},{"name":"Departament de Medicina, Universitat Aut\u00f2noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Ribo","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology, Hospital Vall d\u2019Hebron, Barcelona, Spain"},{"name":"Departament de Medicina, Universitat Aut\u00f2noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1713973"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1706442"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2214403"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2213379"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2118191"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2314063"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.028956"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2408954"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2411668"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2020-016851"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.045228"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A4222"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.5853\/jos.2020.00227"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.5853\/jos.2023.02649"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.037904"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2021.02.123"},{"key":"e_1_3_3_18_2","first-page":"1","article-title":"Arterial tortuosity is a potent determinant of safety in endovascular therapy for acute ischemic stroke","volume":"4","author":"Saber H","year":"2024","unstructured":"Saber H, Colby GP, Mueller-Kronast N, et al. 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