Semi-automated tortuosity measurements confirm generalizability of IMPERATIVE trial results to real-world patients with acute ischemic stroke undergoing thrombectomy

BackgroundCriticism 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.MethodsUsing 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).ResultsOf 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%, <i>p</i> = .038).ConclusionsImperative 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.

Authors

Institutions

Publication Details

Journal
Interventional Neuroradiology
Published
2025-07-21
DOI
https://doi.org/10.1177/15910199251359089
Primary Topic
Acute Ischemic Stroke Management
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Semi-automated tortuosity measurements confirm generalizability of IMPERATIVE trial results to real-world patients with acute ischemic stroke undergoing thrombectomy

David Rosenbaum-Halevi, James Milburn, Shahid M. Nimjee, Reade De Leacy et al.
Interventional Neuroradiology
Acute Ischemic Stroke Management
article

Semi-automated tortuosity measurements confirm generalizability of IMPERATIVE trial results to real-world patients with acute ischemic stroke undergoing thrombectomy

David Rosenbaum-Halevi, James Milburn, Shahid M. Nimjee, Reade De Leacy, Jan Vargas, Jonathan Andrew Grossberg, Neil Haranhalli, William J. Mack, Maxim Mokin, Narlin Beaty, Kennith F. Layton, Justin Robert Mascitelli, Shahram Majidi, Christopher P. Kellner, Kenneth V. Snyder, Alhamza R Al‐Bayati, Matthew Tenser, Brett L. Cucchiara, Benjamin Yim, Michael Nahhas, Harris Hawk, Raul G. Nogueira, Diogo C Haussen, Dan Hoit, Darryn Shaff, Hakeem J Shakir, Victoria Parada, Nima Aghaebrahim, Robert M. Starke, Dana Tomalty, Aqueel Pabaney
article en

Abstract

BackgroundCriticism 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.MethodsUsing 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).ResultsOf 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%, <i>p</i> = .038).ConclusionsImperative 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.

Interventional Neuroradiology
University of Southern California (US), Prisma Health (US), Albert Einstein College of Medicine (US), Lehigh Valley Hospital-Pocono (US), Munson Medical Center (US), Huntsville Hospital (US), Montefiore Medical Center (US), Ochsner Health System (US), John Muir Health (US), Emory University (US), The University of Texas at San Antonio Health Science Center (US), University of South Florida (US), Erlanger Health System (US), Ochsner Medical Center (US), Keck Hospital of USC (US), Emory University Hospital (US), Baylor University Medical Center (US), John Muir Medical Center (US), University of Miami Health System (US), Semmes Murphey Foundation (US), Baptist Medical Center Jacksonville (US), Valley Baptist Medical Center (US), Lehigh Valley Hospital (US), University of Pittsburgh Medical Center (US), Tallahassee Memorial HealthCare (US), Neurological Surgery (US), University of Oklahoma Health Sciences Center (US), University at Buffalo, State University of New York (US), University of Pennsylvania (US), The University of Texas Health Science Center at Houston (US), Icahn School of Medicine at Mount Sinai (US)
Openalex Percentile: Top 75%
Acute Ischemic Stroke Management
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.