Journal article
"Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis"
European stroke journal, Vol.10(1), pp.63-73
03/2025
DOI: 10.1177/23969873241272542
PMCID: PMC11569593
PMID: 39171391
Abstract
Thrombectomy complications remain poorly explored. This study aims to characterize periprocedural intracranial vessel perforation including the effect of thrombolysis on patient outcomes.INTRODUCTIONThrombectomy complications remain poorly explored. This study aims to characterize periprocedural intracranial vessel perforation including the effect of thrombolysis on patient outcomes.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.PATIENTS AND METHODSIn 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.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).RESULTS459 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).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.DISCUSSION AND CONCLUSIONVessel 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.
Details
- Title: Subtitle
- "Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis"
- Creators
- Victor Schulze-Zachau - University Hospital of BaselEdgar A Samaniego - University of IowaDiego J Ojeda - University of IowaNikki Rommers - University of BaselNikolaos Ntoulias - University Hospital of BaselAlex Brehm - University Hospital of BaselNadja Krug - University of BaselIoannis Tsogkas - University Hospital of BaselMatthias Mutke - University Hospital of BaselThilo Rusche - University Hospital of BaselAmedeo Cervo - Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaClaudia Rollo - Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaMarkus Möhlenbruch - University Hospital HeidelbergJessica Jesser - University Hospital HeidelbergKornelia Kreiser - University and Rehabilitation Clinics UlmKatharina Althaus - University Hospital UlmManuel Requena - Vall d'Hebron Hospital UniversitariMarc Rodrigo-Gisbert - Vall d'Hebron Hospital UniversitariTomas Dobrocky - University Hospital of BernBettina L Serrallach - University Hospital of BernChristian H Nolte - Charité - Universitätsmedizin BerlinChristoph Riegler - Charité - Universitätsmedizin BerlinJawed Nawabi - Humboldt-Universität zu BerlinErrikos Maslias - University of LausannePatrik Michel - University of LausanneGuillaume Saliou - University of LausanneNathan Manning - Liverpool HospitalAlexander McQuinn - Liverpool HospitalAlon Taylor - Prince of Wales HospitalChristoph J Maurer - University Hospital AugsburgAnsgar Berlis - University Hospital AugsburgDaniel Po Kaiser - University Hospital Carl Gustav CarusAni Cuberi - University Hospital Carl Gustav CarusManuel Moreu - Hospital Clínico San CarlosAlfonso López-Frías - Hospital Clínico San CarlosCarlos Pérez-García - Hospital Clínico San CarlosRiitta Rautio - Turku University HospitalYlikotila Pauli - Turku University HospitalNicola LimbucciLeonardo RenieriIsabel Fragata - Universidade Nova de LisboaTania Rodriguez-Ares - Unidade Local de Saúde de São JoséJan S Kirschke - Klinikum rechts der IsarJulian Schwarting - Klinikum rechts der IsarSami Al Kasab - Medical University of South CarolinaAlejandro M Spiotta - Medical University of South CarolinaAhmad Abu Qdais - Medical University of South CarolinaAdam A DmytriwRobert W Regenhardt - Brigham and Women's HospitalAman B Patel - Brigham and Women's HospitalVitor Mendes PereiraNicole M Cancelliere - St. Michael's HospitalCarsten SchmeelFranziska Dorn - University Hospital BonnMalte Sauer - University Hospital BonnGrzegorz M Karwacki - Luzerner KantonsspitalJane KhalifeAjith J Thomas - Cooper University HospitalHamza A ShaikhChristian Commodaro - Laboratory for Biomedical NeurosciencesMarco Pileggi - Laboratory for Biomedical NeurosciencesRoland Schwab - Otto-von-Guericke University MagdeburgFlavio Bellante - Grand Charleroi HospitalAnne Dusart - Grand Charleroi HospitalJeremy Hofmeister - University Hospital of GenevaPaolo Machi - University Hospital of GenevaRobert M StarkeAhmed Abdelsalam - Jackson Memorial HospitalFrans van den Bergh - Universitair Ziekenhuis BrusselSylvie De Raedt - Universitair Ziekenhuis BrusselMaxim Bester - Universität HamburgFabian Flottmann - Universität HamburgDaniel WeissMarius Kaschner - Heinrich Heine University DüsseldorfPeter T Kan - The University of Texas Medical Branch at GalvestonGautam Edhayan - The University of Texas Medical Branch at GalvestonMichael R Levitt - University of WashingtonSpencer L Raub - University of WashingtonMira Katan - University Hospital of BaselUrs Fischer - University Hospital of BaselMarios-Nikos Psychogios
- Resource Type
- Journal article
- Publication Details
- European stroke journal, Vol.10(1), pp.63-73
- DOI
- 10.1177/23969873241272542
- PMID
- 39171391
- PMCID
- PMC11569593
- NLM abbreviation
- Eur Stroke J
- ISSN
- 2396-9881
- eISSN
- 2396-9881
- Publisher
- SAGE PUBLICATIONS LTD
- Grant note
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: No project-specific funding was received for this study. V.S.-Z. is recipient of a research grant from Basel University, Basel, Switzerland.
- Language
- English
- Electronic publication date
- 08/22/2024
- Date published
- 03/2025
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984699520602771
Metrics
6 Record Views