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

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  • Additional Information
    • Source:
      Publisher: BMJ Publishing Group Country of Publication: England NLM ID: 101517079 Publication Model: Electronic Cited Medium: Internet ISSN: 1759-8486 (Electronic) Linking ISSN: 17598478 NLM ISO Abbreviation: J Neurointerv Surg Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BMJ Publishing Group, c2009-
    • Subject Terms:
      Thrombectomy*/methods ; Thrombectomy*/adverse effects; Humans ; Female ; Male ; Aged ; Retrospective Studies ; Incidence ; Middle Aged ; Aged, 80 and over ; Treatment Outcome ; Intraoperative Complications/epidemiology ; Intraoperative Complications/etiology ; Cohort Studies
    • Abstract:
      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.
      Competing Interests: Competing interests: None declared.
      (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
    • Contributed Indexing:
      Keywords: Complication; Stroke; Thrombectomy
    • Publication Date:
      Date Created: 20230731 Date Completed: 20240716 Latest Revision: 20240725
    • Publication Date:
      20240726
    • Accession Number:
      10.1136/jnis-2023-020531
    • Accession Number:
      37524518