ABSTRACT
OBJECTIVE: To investigate to what extent aortic arch and carotid artery anatomy relate to clinical and radiological outcome after EVT of acute ischaemic stroke (AIS) patients. 
METHODS: CTA images of 891 patients from the MR CLEAN Registry, a prospective Dutch registry of AIS patients treated with EVT, were evaluated on aortic arch configuration, carotid artery tortuosity and atherosclerosis. Logistic prediction models were developed including baseline patient and radiological characteristics. Added value of vascular parameters for prediction of patient outcome was assessed using likelihood-ratio test for increase in area under the curve (AUC). Effect estimates were used to create risk prediction charts. 
RESULTS: The AUC of the baseline model slightly increased with addition of vascular parameters for clinical outcome (AUC from 0.79 (95% CI, 0.76-0.82) to 0.80 (95% CI, 0.77-0.83);p<0.05) and reperfusion (AUC from 0.54 (95% CI, 0.50-0.58) to 0.60 (95% CI, 0.57-0.64);p<0.05). For EVT discontinuation (target occlusion not reached) AUC of 0.72 (95% CI, 0.65-0.79) was improved to 0.82 (95% CI, 0.77-0.88)(p<0.001). Risk chart for EVT discontinuation showed that increase in predicted probability was most pronounced in the elderly patient (>80 years), where probability increased from 0.02 in absence to 0.86 in presence of complex aortic arch configuration, carotid artery tortuosity and ≥70% carotid artery stenosis. 
CONCLUSION: Clinical outcome of AIS patients after EVT is largely predicted by patients’ baseline characteristics. Prediction of reperfusion remains poor. Impact of vascular anatomy and atherosclerosis is most pronounced for prediction of EVT discontinuation. These results  could have implications for treatment decision in patients with complex vascular anatomy.

IMPACT OF VASCULAR ANATOMY ON CLINICAL AND RADIOLOGICAL OUTCOME OF ENDOVASCULAR TREATMENT OF ACUTE ISCHAEMIC STROKE PATIENTS