{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T15:15:18Z","timestamp":1785942918236,"version":"3.56.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"\n Background and purpose<\/jats:title>\n Cavernous internal carotid artery (ICA) tortuosity may hinder catheter navigation during mechanical thrombectomy (MT) for acute ischemic stroke (AIS). However, its impact on procedural and clinical outcomes remains unclear. This study evaluated the association between cavernous ICA tortuosity, classified by the Lin grading system, and outcomes in patients undergoing MT for middle cerebral artery (MCA) occlusion.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n In this single-center retrospective study, 425 patients with MCA occlusion treated with MT were included. Patients were categorized as tortuous (\n n<\/jats:italic>\n \u202f=\u202f205; Lin III\u2013IV) or non-tortuous (\n n<\/jats:italic>\n \u202f=\u202f220; Lin I\u2013II) based on lateral angiographic assessment. The primary outcome was successful recanalization within 60\u202fmin (puncture-to-recanalization). Secondary outcomes included first-pass success, final eTICI (2c\u20133), intracranial hemorrhage, new territory embolism, and functional outcomes (modified Rankin Scale [mRS]) at discharge and 90\u202fdays. Multivariate logistic regression identified predictors of first-pass success.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Tortuous anatomy was associated with lower first-pass success (43.9% vs. 54.1%;\n p<\/jats:italic>\n \u202f=\u202f0.036), fewer recanalizations within 60\u202fmin (47.3% vs. 57.3%;\n p<\/jats:italic>\n \u202f=\u202f0.040), and more procedural attempts (median 3 vs. 1;\n p<\/jats:italic>\n \u202f=\u202f0.025). Intracranial hemorrhage (35.6% vs. 20.5%;\n p<\/jats:italic>\n \u202f&lt;\u202f0.001) and new territory embolism (5.4% vs. 1.8%;\n p<\/jats:italic>\n \u202f=\u202f0.048) were more frequent in the tortuous group. IA-tPA use was higher in tortuous patients (21.0% vs. 11.4%;\n p<\/jats:italic>\n \u202f=\u202f0.007). Good functional outcome (mRS 0\u20132) at discharge was significantly lower in the tortuous group (38.5% vs. 55.0%;\n p<\/jats:italic>\n \u202f=\u202f0.001). Cavernous tortuosity independently reduced first-pass success (OR\u202f=\u202f0.643; 95%CI: 0.431\u20130.958;\n p<\/jats:italic>\n \u202f=\u202f0.030), while ASPECTS \u22656 (OR\u202f=\u202f1.566;\n p<\/jats:italic>\n \u202f=\u202f0.040) and aspiration technique (OR\u202f=\u202f3.682;\n p<\/jats:italic>\n \u202f&lt;\u202f0.001) were positive predictors.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Cavernous ICA tortuosity is an independent predictor of reduced first-pass success and worse early outcomes in MT. Aspiration may be a more effective strategy in this subgroup, supporting the importance of pre-procedural anatomical assessment.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fneur.2026.1867423","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T14:36:59Z","timestamp":1785940619000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of cavernous internal carotid artery tortuosity on technical and clinical outcomes in mechanical thrombectomy for acute ischemic stroke: a single-center retrospective study"],"prefix":"10.3389","volume":"17","author":[{"given":"Zehra","family":"Uysal Kocaba\u015f","sequence":"first","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, Eskisehir Osmangazi University","place":["Eskisehir, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hicret Bet\u00fcl","family":"Ad\u0131yaman","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sivas Numune Hospital, Ministry of Health","place":["Sivas, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zlem","family":"Ayka\u00e7","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, Eskisehir Osmangazi University","place":["Eskisehir, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atilla \u00d6zcan","family":"\u00d6zdemir","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, Eskisehir Osmangazi University","place":["Eskisehir, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1056\/NEJMoa1411587","article-title":"A randomized trial of intraarterial treatment for acute ischemic stroke","volume":"372","author":"Berkhemer","year":"2015","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e9","DOI":"10.1136\/neurintsurg-2022-018976","article-title":"Predictors and outcome of early neurological deterioration after endovascular thrombectomy: a secondary analysis of the DIRECT-MT trial","volume":"15","author":"Zhang","year":"2023","journal-title":"J Neurointerv Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1002\/acn3.51826","article-title":"Nomogram to predict unfavorable outcome of endovascular thrombectomy for large ischemic core","volume":"10","author":"Han","year":"2023","journal-title":"Ann Clin Transl Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1016\/j.ijom.2017.11.015","article-title":"Tortuous internal carotid artery in the oropharynx: a rare cause of a mass","volume":"47","author":"Vural","year":"2018","journal-title":"Int J Oral Maxillofac Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"i70","DOI":"10.1136\/neurintsurg-2012-010438","article-title":"Difficult catheter access to the occluded vessel during endovascular treatment of acute ischemic stroke is associated with worse clinical outcome","volume":"5","author":"Ribo","year":"2013","journal-title":"J Neurointerv Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1136\/neurintsurg-2014-011298","article-title":"Classification of cavernous internal carotid artery tortuosity: a predictor of procedural complexity in pipeline embolization","volume":"7","author":"Lin","year":"2015","journal-title":"J Neurointerv Surg."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1161\/01.STR.20.7.864","article-title":"Measurements of acute cerebral infarction: a clinical examination scale","volume":"20","author":"Brott","year":"1989","journal-title":"Stroke"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2458","DOI":"10.1161\/STROKEAHA.121.037904","article-title":"Internal carotid artery tortuosity: impact on mechanical thrombectomy","volume":"53","author":"Koge","year":"2022","journal-title":"Stroke"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1136\/neurintsurg-2013-010726","article-title":"The golden hour of stroke intervention: effect of thrombectomy procedural time in acute ischemic stroke on outcome","volume":"6","author":"Spiotta","year":"2014","journal-title":"J Neurointerv Surg."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e109","DOI":"10.1161\/01.STR.0000082721.62796.09","article-title":"for the Technology Assessment Committees of the American Society of Interventional and Therapeutic Neuroradiology and the Society of Interventional Radiology. 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