Incidence and outcome of perforations during medium vessel occlusion compared with large vessel occlusion thrombectomy

被引：17

作者：

Schulze-Zachau, Victor ^{[1
]}

Brehm, Alex ^{[1
]}

Ntoulias, Nikolaos ^{[1
]}

Krug, Nadja ^{[1
]}

Tsogkas, Ioannis ^{[1
]}

Blackham, Kristine Ann ^{[1
]}

Moehlenbruch, Markus A. ^{[2
]}

Jesser, Jessica ^{[2
]}

Cervo, Amedeo ^{[3
]}

Kreiser, Kornelia ^{[4
]}

Althaus, Katharina ^{[5
]}

Maslias, Errikos ^{[6
,7
]}

Michel, Patrik ^{[6
,7
]}

Saliou, Guillaume ^{[7
,8
]}

Riegler, Christoph ^{[9
,10
]}

Nolte, Christian H. ^{[9
,10
]}

Maier, Ilko ^{[11
]}

Jamous, Ala ^{[12
]}

Rautio, Riitta ^{[13
]}

Ylikotila, Pauli ^{[14
]}

Fargen, Kyle M. ^{[15
]}

Wolfe, Stacey Q. ^{[15
]}

Castellano, Davide ^{[16
]}

Boghi, Andrea ^{[16
]}

Kaiser, Daniel P. O. ^{[17
]}

Cuberi, Ani ^{[18
]}

Kirschke, Jan S. ^{[19
]}

Schwarting, Julian ^{[19
]}

Limbucci, Nicola ^{[20
]}

Renieri, Leonardo ^{[20
]}

Al Kasab, Sami ^{[21
]}

Spiotta, Alejandro M. ^{[21
]}

Fragata, Isabel ^{[22
,23
]}

Rodriquez-Ares, Tania ^{[22
]}

Maurer, Christoph Johannes ^{[24
]}

Berlis, Ansgar ^{[24
]}

Moreu, Manuel ^{[25
]}

Lopez-Frias, Alfonso ^{[25
]}

Perez-Garcia, Carlos ^{[25
]}

Commodaro, Christian ^{[26
]}

Pileggi, Marco ^{[26
]}

Mascitelli, Justin ^{[27
]}

Giordano, Flavio ^{[28
]}

Casagrande, Walter ^{[29
]}

Purves, Cynthia P. ^{[29
]}

Bester, Maxim ^{[30
]}

Flottmann, Fabian ^{[30
]}

Kan, Peter T. ^{[31
]}

Edhayan, Gautam ^{[32
]}

Hofmeister, Jeremy ^{[33
]}

机构：

[1] Univ Hosp Basel, Diagnost & Intervent Neuroradiol Dept, Radiol & Nucl Med Clin, CH-4031 Basel, Switzerland

[2] Univ Hosp Heidelberg, Minimal Invas NeuroTherapy Ctr, Vasc & Intervent Neuroradiol Sect, Heidelberg, Germany

[3] Osped Niguarda Ca Granda, Neuroradiol Dept, Milan, Italy

[4] RKU Univ & Rehabil Kliniken Ulm gGmbH, Radiol & Neuroradiol Clin, Ulm, Germany

[5] Ulm Univ Hosp, Neurol Clin, Ulm, Germany

[6] CHU Vaudois, Dept Clin Neurosci, Lausanne, Switzerland

[7] UNIL Univ Lausanne, Lausanne, Switzerland

[8] CHU Vaudois, Diagnost & Intervent Radiol, Lausanne, Switzerland

[9] Charite Univ Med Berlin, Dept Neurol Expt Neurol, Berlin, Germany

[10] Charite Univ Med Berlin, Ctr Stroke Res Berlin, Berlin, Germany

[11] Univ Med Ctr Gottingen, Dept Neurol, Gottingen, Germany

[12] Univ Med Ctr Gottingen, Dept Diagnost & Intervent Neuroradiol, Gottingen, Germany

[13] Turku Univ Hosp, Dept Radiol, Turku, Finland

[14] Turku Univ Hosp, Neuroctr, Turku, Finland

[15] Wake Forest Univ, Neurol Surg & Radiol, Sch Med, Winston Salem, NC USA

[16] Osped San Giovanni Bosco, Dept Intervent Radiol & Neuroradiol, Turin, Italy

[17] Univ Hosp Carl Gustav Carus, Dept Neuroradiol, Dresden, Germany

[18] Univ Hosp Carl Gustav Carus, Dept Radiol, Dresden, Germany

[19] Tech Univ Munich, Diagnost & Intervent Neuroradiol, Klinikum Rechts Isar, Munich, Germany

[20] Azienda Osped Univ Careggio, Dept Neurovasc Intervent, Florence, Italy

[21] Med Univ South Carolina, Dept Neurosurg, Charleston, SC USA

[22] Ctr Hosp Univ Lisboa Cent EPE, Dept Neuroradiol, Lisbon, Portugal

[23] NOVA Med Sch, Lisbon, Portugal

[24] Univ Hosp Augsburg, Diagnost & Intervent Radiol & Neuroradiol, Augsburg, Germany

[25] Hosp Clin Univ San Carlos, Radiol Dept, Neurointervent Unit, Madrid, Spain

[26] Neuroctr Southern Switzerland EOC, Diagnost & Intervent Neuroradiol Dept, Lugano, Switzerland

[27] Univ Texas Hlth Sci Ctr San Antonio, Dept Neurosurg, San Antonio, TX USA

[28] Azienda Ospeda Rilievo Nazl Antonio Cardarelli, Dept Adv Diagnost & Therapeut Technol, Unit Intervent Neuroradiol, Naples, Italy

[29] Hosp Gen Agudos Juan A Fernandez, Neurosurg Dept, Buenos Aires, Argentina

[30] Univ Med Ctr Hamburg Eppendorf, Diagnost & Intervent Neuroradiol Dept, Hamburg, Germany

[31] Univ Texas Med Branch Galveston, Dept Neurosurg, Galveston, TX USA

[32] Univ Texas Med Branch Galveston, Dept Radiol, Galveston, TX USA

[33] Geneva Univ Hosp, Dept Radiol & Med Informat, Geneva, Switzerland

[34] Heinrich Heine Univ Dusseldorf, Dept Diagnost & Intervent Radiol, Dusseldorf, Germany

[35] Univ Hosp Basel, Neurol Clin, Basel, Switzerland

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2024年 / 16卷 / 08期

关键词：

Thrombectomy; Complication; Stroke; ISCHEMIC-STROKE; ENDOVASCULAR THROMBECTOMY; METAANALYSIS;

D O I：

10.1136/jnis-2023-020531

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

BackgroundVessel 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. MethodsIn 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. ResultsDuring 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. ConclusionsIn 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.

引用

页码：775 / 780

页数：7

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