"Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis".

Schulze-Zachau, Victor; Rommers, Nikki; Ntoulias, Nikolaos; Brehm, Alex; Krug, Nadja; Tsogkas, Ioannis; Mutke, Matthias; Rusche, Thilo; Cervo, Amedeo; Rollo, Claudia; Möhlenbruch, Markus; Jesser, Jessica; Kreiser, Kornelia; Althaus, Katharina; Requena, Manuel; Rodrigo-Gisbert, Marc; Dobrocky, Tomas; Serrallach, Bettina L; Nolte, Christian H; Riegler, Christoph; ... (2024). "Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis". (In Press). European stroke journal, 23969873241272542, p. 23969873241272542. Sage 10.1177/23969873241272542

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INTRODUCTION

Thrombectomy complications remain poorly explored. This study aims to characterize periprocedural intracranial vessel perforation including the effect of thrombolysis on patient outcomes.

PATIENTS AND METHODS

In this multicenter retrospective cohort study, consecutive patients with vessel perforation during thrombectomy between January 2015 and April 2023 were included. Vessel perforation was defined as active extravasation on digital subtraction angiography. The primary outcome was modified Rankin Scale (mRS) at 90 days. Factors associated with the primary outcome were assessed using proportional odds models.

RESULTS

459 patients with vessel perforation were included (mean age 72.5 ± 13.6 years, 59% female, 41% received thrombolysis). Mortality at 90 days was 51.9% and 16.3% of patients reached mRS 0-2 at 90 days. Thrombolysis was not associated with worse outcome at 90 days. Perforation of a large vessel (LV) as opposed to medium/distal vessel perforation was independently associated with worse outcome at 90 days (aOR 1.709, p = 0.04) and LV perforation was associated with poorer survival probability (HR 1.389, p = 0.021). Patients with active bleeding >20 min had worse survival probability, too (HR 1.797, p = 0.009). Thrombolysis was not associated with longer bleeding duration. Bleeding cessation was achieved faster by permanent vessel occlusion compared to temporary measures (median difference: 4 min, p < 0.001).

DISCUSSION AND CONCLUSION

Vessel perforation during thrombectomy is a severe and frequently fatal complication. This study does not suggest that thrombolysis significantly attributes to worse prognosis. Prompt cessation of active bleeding within 20 min is critical, emphasizing the need for interventionalists to be trained in complication management.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Dobrocky, Tomas, Serrallach, Bettina Lara

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2396-9873

Publisher:

Sage

Language:

English

Submitter:

Pubmed Import

Date Deposited:

23 Aug 2024 10:14

Last Modified:

24 Aug 2024 00:16

Publisher DOI:

10.1177/23969873241272542

PubMed ID:

39171391

Uncontrolled Keywords:

Stroke complication intracranial hemorrhage intraoperative thrombectomy thrombolysis

BORIS DOI:

10.48350/199926

URI:

https://boris.unibe.ch/id/eprint/199926

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