A1 Refereed original research article in a scientific journal
Incidence and outcome of perforations during medium vessel occlusion compared with large vessel occlusion thrombectomy
Authors: Schulze-Zachau, Victor; Brehm, Alex; Ntoulias, Nikolaos; Krug, Nadja; Tsogkas, Ioannis; Blackham, Kristine Ann; Möhlenbruch, Markus A.; Jesser, Jessica; Cervo, Amedeo; Kreiser, Kornelia; Althaus, Katharina; Maslias, Errikos; Michel, Patrik; Saliou, Guillaume; Riegler, Christoph; Nolte, Christian H.; Maier, Ilko; Jamous, Ala; Rautio, Riitta; Ylikotila, Pauli; Fargen, Kyle M.; Wolfe, Stacey Q.; Castellano, Davide; Boghi, Andrea; Kaiser, Daniel P. O.; Cuberi, Ani; Kirschke, Jan S.; Schwarting, Julian; Limbucci, Nicola; Renieri, Leonardo; Al Kasab, Sami; Spiotta, Alejandro M.; Fragata, Isabel; Rodriquez-Ares, Tania; Maurer, Christoph Johannes; Berlis, Ansgar; Moreu, Manuel; López-Frías, Alfonso; Pérez-García, Carlos; Commodaro, Christian; Pileggi, Marco; Mascitelli, Justin; Giordano, Flavio; Casagrande, Walter; Purves, Cynthia P.; Bester, Maxim; Flottmann, Fabian; Kan, Peter T.; Edhayan, Gautam; Hofmeister, Jeremy; Machi, Paolo; Kaschner, Marius; Weiss, Daniel; Katan, Mira; Fischer, Urs; Psychogios, Marios-Nikos
Publisher: BMJ PUBLISHING GROUP
Publication year: 2024
Journal: Journal of NeuroInterventional Surgery
Journal name in source: JOURNAL OF NEUROINTERVENTIONAL SURGERY
Journal acronym: J NEUROINTERV SURG
Volume: 16
Issue: 8
First page : 775
Last page: 780
Number of pages: 7
ISSN: 1759-8478
eISSN: 1759-8486
DOI: https://doi.org/10.1136/jnis-2023-020531
Publication's open availability at the time of reporting: No Open Access
Publication channel's open availability : Partially Open Access publication channel
Web address : https://jnis.bmj.com/content/early/2023/07/31/jnis-2023-020531
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/180990075
Self-archived copy's licence: other license
Self-archived copy's version: Final draft
Background
Vessel perforation during thrombectomy is a severe complication and is hypothesized to be more frequent during medium vessel occlusion (MeVO) thrombectomy. The aim of this study was to compare the incidence and outcome of patients with perforation during MeVO and large vessel occlusion (LVO) thrombectomy and to report on the procedural steps that led to perforation.
Methods
In this multicenter retrospective cohort study, data of consecutive patients with vessel perforation during thrombectomy between January 1, 2015 and September 30, 2022 were collected. The primary outcomes were independent functional outcome (ie, modified Rankin Scale 0-2) and all-cause mortality at 90 days. Binomial test, chi-squared test and t-test for unpaired samples were used for statistical analysis.
Results
During 25 769 thrombectomies (5124 MeVO, 20 645 LVO) in 25 stroke centers, perforation occurred in 335 patients (1.3%; mean age 72 years, 62% female). Perforation occurred more often in MeVO thrombectomy (2.4%) than in LVO thrombectomy (1.0%, p<0.001). More MeVO than LVO patients with perforation achieved functional independence at 3 months (25.7% vs 10.9%, p=0.001). All-cause mortality did not differ between groups (overall 51.6%). Navigation beyond the occlusion and retraction of stent retriever/aspiration catheter were the two most common procedural steps that led to perforation.
Conclusions
In our cohort, perforation was approximately twice as frequent in MeVO than in LVO thrombectomy. Efforts to optimize the procedure may focus on navigation beyond the occlusion site and retraction of stent retriever/aspiration catheter. Further research is necessary in order to identify thrombectomy candidates at high risk of intraprocedural perforation and to provide data on the effectiveness of endovascular countermeasures.
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