Evaluation of the association between the internal carotid artery and vertebral artery tortuosity and acute ischemic stroke using tortuosity index

Objective To determine the association between the tortuosity of the internal carotid artery and vertebral artery and the occurrence of acute ischemic stroke based on a new quantitative method. Methods This retrospective case-control study was conducted on 63 patients diagnosed with acute ischemic stroke in the case group and 52 patients in the control group. All the participants underwent neck Computed Tomography Angiography. The images were retrospectively reviewed and the tortuosity index was measured for internal carotid and vertebral artery. Then, a multivariable binary logistic regression model adjusted for the potential confounders was performed to assess the independent effect of internal carotid/vertebral artery tortuosity on acute ischemic stroke. Results Analysis of the logistic regression model revealed a significant effect of the internal carotid artery tortuosity index on anterior territory infarction (odds ratio = 1.04, p = 0.01) as well as a significant effect of the vertebral artery tortuosity index on posterior territory infarction (odds ratio = 1.14, p < 0.001). The optimal cut-off points for the internal carotid and vertebral artery tortuosity were 16.91 and 22.96, respectively. Conclusions This study showed that tortuosity of extracranial portions of the internal carotid and vertebral artery could be an independent imaging predictor of acute ischemic stroke in anterior and posterior circulation territories, respectively.