Iatrogenic Vessel Dissection in Endovascular Treatment of Acute Ischemic Stroke.

Goeggel Simonetti, Barbara; Hulliger, Justine; Mathier, Etienne; Jung, Simon; Fischer, Urs; Sarikaya, Hakan; Slotboom, Johannes; Schroth, Gerhard; Mordasini, Pasquale; Gralla, Jan; Arnold, Marcel (2019). Iatrogenic Vessel Dissection in Endovascular Treatment of Acute Ischemic Stroke. Clinical neuroradiology, 29(1), pp. 143-151. Springer 10.1007/s00062-017-0639-z

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PURPOSE Knowledge 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. METHODS Digital 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. RESULTS Out of 866 patients 18 (2%) suffered an ID (44% female, median age 64 years). Localization was extracranial in 15 (83%, 14 internal carotid artery and 1 vertebral artery) and intracranial in 3 (17%; 1 vertebrobasilar dissection and 2 in the anterior circulation). Of the IDs 5 (28%) resulted in a high-degree, 3 (17%) in a moderate, 5 (28%) in a mild and 5 (28%) in no stenosis and 8 IDs were stented in the acute phase. At 3 months 7 (42%) patients had a favorable outcome (modified Rankin score mRS ≤ 2) and 6 (33%) patients had died. Patients with ID had a different 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. CONCLUSION The occurrence of ID is a rare complication of endovascular AIS treatment associated with smoking and mechanical thrombectomy.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Radiation Oncology

UniBE Contributor:

Goeggel Simonetti, Barbara; Mathier, Etienne; Jung, Simon; Fischer, Urs; Sarikaya, Hakan; Slotboom, Johannes; Schroth, Gerhard; Mordasini, Pasquale; Gralla, Jan and Arnold, Marcel

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1869-1439

Publisher:

Springer

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

06 Dec 2017 15:41

Last Modified:

28 Feb 2019 01:30

Publisher DOI:

10.1007/s00062-017-0639-z

PubMed ID:

29098320

Uncontrolled Keywords:

Dissection Endovascular treatment Iatrogenic Interventional neuroradiology Ischemic stroke

BORIS DOI:

10.7892/boris.106900

URI:

https://boris.unibe.ch/id/eprint/106900

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