“Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis”-Reference-Cited by-同舟云学术

“Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis”

Published:2024-08-22 Issue: Volume: Page:
ISSN:2396-9873
Container-title:European Stroke Journal
language:en
Short-container-title:European Stroke Journal

Author:

Schulze-Zachau Victor¹^ORCID,Rommers Nikki²,Ntoulias Nikolaos¹,Brehm Alex¹^ORCID,Krug Nadja¹,Tsogkas Ioannis¹,Mutke Matthias¹,Rusche Thilo¹,Cervo Amedeo³,Rollo Claudia³,Möhlenbruch Markus⁴^ORCID,Jesser Jessica⁴^ORCID,Kreiser Kornelia⁵,Althaus Katharina⁶,Requena Manuel⁷^ORCID,Rodrigo-Gisbert Marc⁸^ORCID,Dobrocky Tomas⁹,Serrallach Bettina L⁹,Nolte Christian H¹⁰¹¹^ORCID,Riegler Christoph¹⁰¹¹^ORCID,Nawabi Jawed¹²¹³,Maslias Errikos¹⁴,Michel Patrik¹⁴,Saliou Guillaume¹⁵,Manning Nathan¹⁶¹⁷,McQuinn Alexander¹⁶¹⁷,Taylor Alon¹⁷,Maurer Christoph J¹⁸,Berlis Ansgar¹⁸,Kaiser Daniel PO¹⁹,Cuberi Ani²⁰,Moreu Manuel²¹^ORCID,López-Frías Alfonso²¹,Pérez-García Carlos²¹,Rautio Riitta²²,Pauli Ylikotila²²,Limbucci Nicola²³,Renieri Leonardo²³,Fragata Isabel²⁴²⁵,Rodriguez-Ares Tania²⁵,Kirschke Jan S²⁶^ORCID,Schwarting Julian²⁶^ORCID,Al Kasab Sami²⁷,Spiotta Alejandro M²⁷,Abu Qdais Ahmad²⁸,Dmytriw Adam A²⁹³⁰,Regenhardt Robert W²⁹,Patel Aman B²⁹,Pereira Vitor Mendes³⁰,Cancelliere Nicole M³⁰,Schmeel Carsten³¹,Dorn Franziska³¹,Sauer Malte³¹,Karwacki Grzegorz M³²,Khalife Jane³³,Thomas Ajith J³⁴,Shaikh Hamza A³⁵,Commodaro Christian³⁶,Pileggi Marco³⁶,Schwab Roland³⁷^ORCID,Bellante Flavio³⁸^ORCID,Dusart Anne³⁸,Hofmeister Jeremy³⁹,Machi Paolo³⁹,Samaniego Edgar A⁴⁰⁴¹⁴²,Ojeda Diego J⁴²,Starke Robert M⁴³,Abdelsalam Ahmed⁴³,van den Bergh Frans⁴⁴^ORCID,De Raedt Sylvie⁴⁵,Bester Maxim⁴⁶,Flottmann Fabian⁴⁶,Weiss Daniel⁴⁷,Kaschner Marius⁴⁷,Kan Peter T⁴⁸,Edhayan Gautam⁴⁸,Levitt Michael R⁴⁹,Raub Spencer L⁴⁹,Katan Mira²⁵⁰,Fischer Urs²⁵⁰,Psychogios Marios-Nikos¹²

Affiliation:

1. Department of Diagnostic & Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland

2. Clinical Research Department, University Basel, Basel, Switzerland

3. Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Milano, Italy

4. Vascular & Interventional Neuroradiology Section, Minimal Invasive NeuroTherapy Center, Heidelberg University Hospital, Heidelberg, Germany

5. Radiology and Neuroradiology Clinic, University and Rehabilitation Clinic Ulm, Ulm, Germany

6. Neurology Clinic, University Hospital Ulm, Ulm, Germany

7. Interventional Neuroradiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain

8. Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain

9. Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland

10. Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany

11. Center for Stroke Research Berlin (CSBand Berlin Institute of Healths (BIH), Charité Universitätsmedizin Berlin, Berlin, Germany

12. Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany

13. Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany

14. Stroke Center, Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland

15. Interventional Neuroradiological Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland

16. Department of Interventional Radiology, Liverpool Hospital, Sydney, Australia

17. Neurointervention and Neurovascular Clinic, Prince of Wales Hospital, Sydney, Australia

18. Department of Diagnostic and Interventional Neuroradiology, Augsburg University Hospital, Germany

19. Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany

20. Department of Radiology, University Hospital Carl Gustav Carus, Dresden, Germany

21. Neurointerventional Unit, Radiology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain

22. Department of Interventional Radiology, Turku University Hospital, Finland

23. Department of Neurovascular Intervention, Ospedale Careggi di Firenze, Florence, Italy

24. NOVA Medical School, Lisbon, Portugal

25. Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

26. Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany

27. Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA

28. Department of Neurology, Medical University of South Carolina, Charleston, SC, USA

29. Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

30. Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada

31. Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany

32. Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, Luzern, Switzerland

33. Department of Neurology, Cooper Neurological Institute, Camden, NJ, USA

34. Department of Neurosurgery, Cooper Neurological Institute, Camden, NJ, USA

35. Department of Neurointerventional Surgery, Cooper Neurological Institute, Camden, NJ, USA

36. Department of Diagnostic and Interventional Neuroradiology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland

37. University Clinic for Neuroradiology, Medical Faculty, Otto-Von-Guericke-University, Magdeburg, Germany

38. Service de Neurologie, CHU de Charleroi, Charleroi, Belgium

39. Service of Diagnostic and Interventional Neuroradiology, Geneva University Hospital, Geneva, Switzerland

40. Department of Neurology, University of Iowa, College of Medicine, Iowa City, IA, USA

41. Department of Neurosurgery, University of Iowa, College of Medicine, Iowa City, IA, USA

42. University of Iowa, College of Medicine, Iowa City, IA, USA

43. Miami Miller School of Medicine, Jackson Memorial Hospital, University of Miami Hospital, Miami, USA

44. Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium

45. Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium

46. Department of Neuroradiology, University Hospital Eppendorf, Hamburg, Germany

47. Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany

48. Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA

49. Department of Neurosurgery, University of Washington, Seattle, Washington, USA

50. Neurology Clinic, University Hospital Basel, Basel, Switzerland

Abstract

Introduction: Thrombectomy complications remain poorly explored. This study aims to characterize periprocedural intracranial vessel perforation including the effect of thrombolysis on patient outcomes. Patients and methods: In this multicenter retrospective cohort study, consecutive patients with vessel perforation during thrombectomy between January 2015 and April 2023 were included. Vessel perforation was defined as active extravasation on digital subtraction angiography. The primary outcome was modified Rankin Scale (mRS) at 90 days. Factors associated with the primary outcome were assessed using proportional odds models. Results: 459 patients with vessel perforation were included (mean age 72.5 ± 13.6 years, 59% female, 41% received thrombolysis). Mortality at 90 days was 51.9% and 16.3% of patients reached mRS 0–2 at 90 days. Thrombolysis was not associated with worse outcome at 90 days. Perforation of a large vessel (LV) as opposed to medium/distal vessel perforation was independently associated with worse outcome at 90 days (aOR 1.709, p = 0.04) and LV perforation was associated with poorer survival probability (HR 1.389, p = 0.021). Patients with active bleeding >20 min had worse survival probability, too (HR 1.797, p = 0.009). Thrombolysis was not associated with longer bleeding duration. Bleeding cessation was achieved faster by permanent vessel occlusion compared to temporary measures (median difference: 4 min, p < 0.001). Discussion and conclusion: Vessel perforation during thrombectomy is a severe and frequently fatal complication. This study does not suggest that thrombolysis significantly attributes to worse prognosis. Prompt cessation of active bleeding within 20 min is critical, emphasizing the need for interventionalists to be trained in complication management.

Publisher

SAGE Publications

Link

https://journals.sagepub.com/doi/pdf/10.1177/23969873241272542

Reference23 articles.

1. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials

2. Expanding indications for endovascular thrombectomy-how to leave no patient behind

3. Mechanical Thrombectomy Versus Best Medical Treatment in the Late Time Window in Non-DEFUSE-Non-DAWN Patients: A Multicenter Cohort Study