Iatrogenic Vessel Dissection in Endovascular Treatment of Acute Ischemic Stroke

PurposeKnowledge about the localization and outcome of iatrogenic dissection (ID) during endovascular treatment of acute ischemic stroke (AIS) is limited. We aimed to determine the frequency, clinical aspects and morphology of ID in endovascular AIS treatment and to identify predictors of this complication.MethodsDigital subtraction angiography (DSA) of ID carried out during endovascular treatment between January 2000 and March 2012 have been re-evaluated. The ID localization and morphology were analyzed and related to the interventional techniques. Baseline clinical and radiological findings, treatment modality and outcome were compared with patients without ID.ResultsOut of 866 patients 18 (2%) suffered an ID (44% female, median age 64years). Localization was extracranial in 15 (83%, 14internal carotid artery and 1vertebral artery) and intracranial in 3 (17%; 1vertebrobasilar dissection and 2 in the anterior circulation). Of the IDs 5 (28%) resulted in ahigh-degree, 3 (17%) in amoderate, 5 (28%) in amild and 5 (28%) in no stenosis and 8 IDs were stented in the acute phase. At 3months 7 (42%) patients had afavorable outcome (modified Rankin score mRS 2) and 6 (33%) patients had died. Patients with ID had adifferent stroke etiology (p= 0.041), were more likely to be smokers (44% versus 19%, p= 0.015) and were more likely to be treated with mechanical thrombectomy (100% versus 60%, p< 0.001). Although two ID patients had relevant complications, the outcome did not differ between the groups.ConclusionThe occurrence of ID is arare complication of endovascular AIS treatment associated with smoking and mechanical thrombectomy.