Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study

被引：22

作者：

Dmytriw, Adam A. ^{[1
,2
,3
,55
]}

Musmar, Basel ^{[4
]}

Salim, Hamza ^{[5
]}

Ghozy, Sherief ^{[6
]}

Siegler, James E. ^{[7
]}

Kobeissi, Hassan ^{[6
]}

Shaikh, Hamza ^{[7
]}

Khalife, Jane ^{[7
]}

Abdalkader, Mohamad ^{[8
,9
]}

Klein, Piers ^{[8
,9
]}

Nguyen, Thanh N. ^{[8
]}

Heit, Jeremy J. ^{[10
]}

Regenhardt, Robert W. ^{[1
]}

Cancelliere, Nicole M. ^{[2
,3
]}

Bernstock, Joshua D. ^{[11
]}

El Naamani, Kareem ^{[12
]}

Amllay, Abdelaziz ^{[12
]}

Meyer, Lukas ^{[13
]}

Dusart, Anne ^{[14
]}

Bellante, Flavio ^{[14
]}

Forestier, Geraud ^{[15
]}

Rouchaud, Aymeric ^{[15
]}

Saleme, Suzana ^{[15
]}

Mounayer, Charbel ^{[15
]}

Fiehler, Jens ^{[13
]}

Kuhn, Anna Luisa ^{[16
]}

Puri, Ajit S. ^{[16
]}

Dyzmann, Christian ^{[17
]}

Kan, Peter T. ^{[18
]}

Colasurdo, Marco ^{[18
,19
]}

Marnat, Gaultier ^{[20
]}

Berge, Jerome ^{[20
]}

Barreau, Xavier ^{[20
]}

Sibon, Igor ^{[21
]}

Nedelcu, Simona ^{[22
]}

Henninger, Nils ^{[22
,23
,24
]}

Marotta, Thomas R. ^{[2
,3
]}

Stapleton, Christopher J. ^{[1
]}

Rabinov, James D. ^{[1
]}

Ota, Takahiro ^{[25
]}

Dofuku, Shogo ^{[25
]}

Yeo, Leonard L. L. ^{[26
]}

Tan, Benjamin Y. Q. ^{[26
,27
]}

Gopinathan, Anil ^{[26
,27
]}

Martinez-Gutierrez, Juan Carlos ^{[28
]}

Salazar-Marioni, Sergio ^{[28
]}

Sheth, Sunil ^{[29
]}

Renieri, Leonardo ^{[29
]}

Capirossi, Carolina ^{[29
]}

Mowla, Ashkan ^{[30
]}

机构：

[1] Harvard Med Sch, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA USA

[2] Univ Toronto, St Michaels Hosp, Neurovasc Ctr, Div Therapeut Neuroradiol, Toronto, ON, Canada

[3] Univ Toronto, St Michaels Hosp, Neurovasc Ctr, Div Neurosurg, Toronto, ON, Canada

[4] Louisiana State Univ, Dept Neurosurg & Intervent Neuroradiol, Shreveport, LA USA

[5] Johns Hopkins Med Ctr, Dept Radiol, Div Neuroradiol, Baltimore, MD USA

[6] Mayo Clin, Dept Neurol Surg & Radiol, Rochester, MN USA

[7] Rowen Univ, Cooper Univ Hosp, Cooper Neurol Inst, Cooper Med Sch, Camden, NJ USA

[8] Boston Med Ctr, Dept Radiol, Boston, MA USA

[9] Boston Med Ctr, Dept Neurol, Boston, MA USA

[10] Stanford Med Ctr, Dept Intervent Neuroradiol, Palo Alto, CA USA

[11] Brigham & Womens Hosp, Dept Neurosurg, Boston, MA USA

[12] Thomas Jefferson Univ, Dept Neurosurg, Philadelphia, PA USA

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

[14] Hop Civil Marie Curie, Dept Neurol, Charleroi, Belgium

[15] Univ Limoges, Univ Hosp Limoges, Neuroradiol Dept, Dupuytren,XLIM,CNRS, Limoges, France

[16] Univ Massachusetts, Dept Radiol, Div Neurointervent Radiol, Med Ctr, Worcester, MA USA

[17] Sana Kliniken Lubeck GmbH, Neuroradiol Dept, Lubeck, Germany

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

[19] Oregon Hlth & Sci Univ, Dept Intervent Radiol, Portland, OR USA

[20] Bordeaux Univ Hosp, Intervent Neuroradiol Dept, Bordeaux, France

[21] Bordeaux Univ Hosp, Neurol Dept, Bordeaux, France

[22] Univ Massachusetts, Dept Neurol, Chan Med Sch, Worcester, MA USA

[23] Univ Massachusetts, Dept Psychiat, Chan Med Sch, Worcester, MA USA

[24] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Neurol, Boston, MA USA

[25] Tokyo Metropolitan Tama Med Ctr, Dept Neurosurg, Fuchu, Japan

[26] Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Med, Singapore, Singapore

[27] Natl Univ Singapore Hosp, Dept Med, Div Neurol, Singapore, Singapore

[28] UTHlth, Dept Neurol, McGovern Med Sch, Houston, TX USA

[29] Osped Careggi Firenze, Interventist Neurovasc, Florence, Italy

[30] Univ Southern Calif, Keck Sch Med, Dept Neurol Surg, Div Stroke & Endovasc Neurosurg, Los Angeles, CA USA

[31] Univ Cincinnati, Dept Neurol & Radiol, Cincinnati, OH USA

[32] Rutgers New Jersey Med Sch, Dept Endovasc Neurosurg & Neuroradiol, Newark, NJ USA

[33] New York Med Coll, Westchester Med Ctr, Dept Neurosurg, Valhalla, NY USA

[34] Hop La Pitie Salpetriere, Dept Neuroradiol, Paris, France

[35] Sorbonne Univ, GRC BioFast, Paris, France

[36] Tanta Univ, Fac Med, Neurol Dept, Tanta, Egypt

[37] Fdn Policlin Univ A Gemelli IRCCS Roma, UOSA Neuroradiol Interventist, Florence, Italy

[38] Ctr Hosp Univ Porto, Dept Diagnost & Intervent Neuroradiol, Porto, Portugal

[39] Cedars Sinai Med Ctr, Dept Neurosurg, Los Angeles, CA USA

[40] Univ Klinikum Heidelberg, Sekt Vaskulare & Intervent Neuroradiol, Heidelberg, Germany

[41] Montpellier Univ, Gui De Chauliac Hosp, Dept Neuroradiol, Med Ctr, Montpellier, France

[42] Montpellier Univ, Gui De Chauliac Hosp, Dept Neurol, Med Ctr, Montpellier, France

[43] Univ Cincinnati, Dept Neurol, Med Ctr, Cincinnati, OH USA

[44] Nancy Univ Hosp, Dept Intervent Neuroradiol, Nancy, France

[45] Univ Lorraine, INSERM U1254, IADI, Vandoeuvre Les Nancy, France

[46] Univ Med Ctr Munster, Dept Radiol, Intervent Neuroradiol Sect, Munster, Germany

[47] Paracelsus Med Univ, Dept Neurol & Neurosurg, Christian Doppler Clin, Salzburg, Austria

[48] Sin Lau Hosp, Neurol Dept, Tainan, Taiwan

[49] Univ Calif Los Angeles, UCLA Stroke Ctr, Los Angeles, CA USA

[50] Univ Calif Los Angeles, Dept Neurol Dept, Los Angeles, CA USA

来源：

EUROPEAN STROKE JOURNAL | 2024年 / 9卷 / 02期

基金：

美国国家卫生研究院;

关键词：

Stroke; AIS; MeVo; perforation; mechanical thrombectomy; MT; ENDOVASCULAR TREATMENT; RANDOMIZED-TRIAL; STENT-RETRIEVER; SAFETY;

D O I：

10.1177/23969873231219412

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO. Methods: Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. A total of 1373 AIS patients with MeVO underwent MT. Baseline characteristics, procedural details, and clinical outcomes were analyzed. Results: The incidence of vessel perforation was 4.8% (66/1373). Notably, our analysis indicates variations in perforation rates across different arterial segments: 8.9% in M3 segments, 4.3% in M2 segments, and 8.3% in A2 segments (p = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, p < 0.001; TICI 2b-3: 56.5% vs 88.3%, p < 0.001). Functional outcomes were also worse in the perforation group (mRS 0-1 at 3 months: 22.7% vs 36.6%, p = 0.031; mRS 0-2 at 3 months: 28.8% vs 53.9%, p < 0.001). Mortality was higher in the perforation group (30.3% vs 16.8%, p = 0.008). Conclusion: This study reveals that while the occurrence of vessel perforation in MT for AIS due to MeVO is relatively rare, it is associated with poor functional outcomes and higher mortality. The findings highlight the need for increased caution and specialized training in performing MT for MeVO. Further prospective research is required for risk mitigation strategies.

引用

页码：328 / 337

页数：10

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