Thrombectomy Complications in Large Vessel Occlusions: Incidence, Predictors, and Clinical Impact in the ETIS Registry
Author:
Happi Ngankou Emmanuel1ORCID, Gory Benjamin12ORCID, Marnat Gaultier3ORCID, Richard Sébastien45ORCID, Bourcier Romain6ORCID, Sibon Igor7ORCID, Dargazanli Cyril8ORCID, Arquizan Caroline9, Maïer Benjamin10, Blanc Raphaël10, Lapergue Bertrand11, Consoli Arturo12ORCID, Vannier Stéphane13ORCID, Spelle Laurent14ORCID, Denier Christian15ORCID, Boulanger Marion16ORCID, Gauberti Maxime17, Saleme Suzana18ORCID, Macian Francisco19, Clarençon Frédéric20ORCID, Rosso Charlotte21, Naggara Olivier22ORCID, Turc Guillaume23ORCID, Ozkul-Wermester Ozlem24ORCID, Papagiannaki Chrysanthi25ORCID, Viguier Alain26ORCID, Cognard Christophe27ORCID, Lebras Anthony28, Evain Sarah29ORCID, Wolff Valérie30, Pop Raoul31ORCID, Timsit Serge32ORCID, Gentric Jean-Christophe33, Bourdain Frédéric34, Veunac Louis35, Eugène François36ORCID, Finitsis Stephanos37ORCID, Piotin Michel, Redjem Hocine, Escalard Simon, Dessilles Jean-Philippe, Delvoye François, Smajda Stanislas, Solène Hebert, Mazighi Mikael, Obadia Mikael, Sabben Candice, Seners Pierre, Raynouard Igor, Corabianu Ovide, de Broucker Thomas, Manchon Eric, Taylor Guillaume, Maacha Malek Ben, Thion Laurie-Anne, Lecler Augustin, Savatovsjy Julien, Wang Adrien, Evrard Serge, Tchikviladze Maya, Ajili Nadia, WeisenburgerLile David, Gorza Lucas, Buard Géraldine, Coskun Oguzhan, Di Maria Federico, Rodesh Georges, Zimatore Sergio, Leguen Morgan, Gratieux Julie, Pico Fernando, Rakotoharinandrasana Haja, Tassan Philippe, Poll Roxanna, Marinier Sylvie, Gariel Florent, Barreau Xavier, Berge Jérôme, Menegon Patrice, Lucas Ludovic, Olindo Stéphane, Renou Pauline, Sagnier Sharmila, Poli Mathilde, Debruxelles Sabrina, Rouanet François, Tourdias Thomas, Liegey Jean-Sebastien, Briau Pierre, Pangon Nicolas, Detraz Lili, Daumas-Duport Benjamin, Alexandre Pierre-Louis, Roy Monica, Lenoble Cédric, Desal Hubert, Guillon Benoît, de Gaalon Solène, Preterre Cécile, Bracard Serge, Anxionnat René, Braun Marc, Derelle Anne-Laure, Liao Liang, Zhu François, Schmitt Emmanuelle, Planel Sophie, Humbertjean Lisa, Mione Gioia, Lacour Jean-Christophe, Riou-Comte Nolwenn, Audibert Gérard, Voicu Marcela, Alb Lionel, Reitter Marie, Brezeanu Madalina, Masson Agnès, Tabarna Adriana, Podar Iona, Guy Sarah, Bechiri Fatiha, Bourst Pauline, Mounayer Charbel, Rouchaud Aymeric, Gimenez Laetitia, Cosnard Alexandre, Costalat Vincent, Gascou Grégory, Lefèvre Pierre-Henri, Derraz Imad, Riquelme Carlos, Gaillard Nicolas, Mourand Isabelle, Corti Lucas, Cagnazzo Federico, ter Schiphorst Adrien, Ferre Jean-Christophe, Raoult Hélène, Ronziere Thomas, Lassale Maria, Paya Christophe, Gauvrit Jean-Yves, Tracol Clément, Langnier-Lemercier Sophie, Maurice Axelle, Cochennec Sabrina, Pinault Mélanie, Shotar Eimad, Sourour Nader, Lenck Stéphanie, Premat Kévin, Léger Yves Samson Anne, Crozier Sophie, Baronnet Flore, Alamowitch Sonia, Bottin Laure, Yger Mathon, Degos Vincent, Chassin Olivier, Chalumeau Vanessa, Caroff Jildaz, Chassin Olivier, Venditti Laura, Sarov Mariana, Legris Nicolas, Hassen Wagih Ben, Boulouis Grégoire, Rodriguez-Régent Christine, Trystram Denis, Kerleroux Basile, Seners Pierre, Domigo Valérie, Lamy Catherine, Birchenall Julia, Isabel Clothilde, Lun François, Januel Anne Christine, Olivot Jean-Marc, Fontaine Louis, Raposo Nicolas, Bonneville Fabrice, Albucher Jean François, Calviere Lionel, Darcourt Jean, Bellanger Guillaume, Tall Philippe, Touze Emmanuel, Barbier Charlotte, Schneckenburger Romain, Cogez Julien, Guettier Sophie, Ognard Julien, Merrien Francois Mathias, Wermester Ozlem Ozku, Massardier Evelyne, Triquenot Aude, Lefebvre Margeaux, Bernady Patricia, Lagoarde-Segot Laurent, Cailliez Hélène, Higue David, Quenardelle Veronique, Lauer Valerie, Gheoca Roxana, Pierre-Paul Irene, Beaujeux Remy, Mihoc Dan, Manisor Monica, Pottecher Julien, Meyer Alain, Chamaraux-Tran Thiên-Nga, Le Bras AnthonyORCID, Le Guen Arnaud
Affiliation:
1. Department of Diagnostic and Therapeutic Neuroradiology (E.H.N., B.G.), Université de Lorraine, CHRU-Nancy, France. 2. IADI, INSERM U1254, Université de Lorraine, Nancy, France (B.G.). 3. Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, France (G.M.). 4. Department of Neurology, Stroke Unit (S.R.), Université de Lorraine, CHRU-Nancy, France. 5. CIC-P 1433, INSERM U1116, CHRU-Nancy, France (S.R.). 6. Department of Neuroradiology, University Hospital of Nantes, France (R.B.). 7. Department of Neurology, Stroke Center, University Hospital of Bordeaux, France (I.S.). 8. Department of Interventional Neuroradiology (C.D.), CHRU Gui de Chauliac, Montpellier, France. 9. Department of Neurology (C.A.), CHRU Gui de Chauliac, Montpellier, France. 10. Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (B.M., R.B.). 11. Department of Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France. 12. Department of Diagnostic and Interventional Neuroradiology (A.C.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France. 13. Department of Neurology, Stroke Unit (S.V.), University Hospital of Rennes, France. 14. Neuroradiolology (L.S.), CHU Kremlin Bicêtre, Paris, France. 15. Departments of Neurology (C.D.), CHU Kremlin Bicêtre, Paris, France. 16. Departments of Neurology (M.B.), CHU Caen, France. 17. Neuroradiolology (M.G.), CHU Caen, France. 18. Department of Interventional Neuroradiology (S.S.), CHU Limoges, France. 19. Neurology, Stroke Unit (F.M.), CHU Limoges, France. 20. Neuroradiolology (F.C.), CHU Pitié-Salpétrière, Paris, France. 21. Departments of Neurology (C.R.), CHU Pitié-Salpétrière, Paris, France. 22. Neuroradiolology (O.N.), Hôpital Saint Anne, Paris, France. 23. Departments of Neurology (G.T.), Hôpital Saint Anne, Paris, France. 24. Departments of Neurology (O.O.-W.), CHU Rouen, France. 25. Neuroradiolology (C.P.), CHU Rouen, France. 26. Departments of Neurology (A.V.), CHU Toulouse, France. 27. Neuroradiolology (C.C.), CHU Toulouse, France. 28. Departments of Neurology (A.L.), CH Bretagne Atlantique, Vannes, France. 29. Neuroradiolology (S.E.), CH Bretagne Atlantique, Vannes, France. 30. Departments of Neurology (V.W.), CHU Strasbourg, France. 31. Neuroradiolology (R.P.), CHU Strasbourg, France. 32. Departments of Neurology (S.T.), CHU Brest, France. 33. Neuroradiolology (J.-C.G.), CHU Brest, France. 34. Departments of Neurology (F.B.), CH Côte Basque, Bayonne, France. 35. Neuroradiolology (L.V.), CH Côte Basque, Bayonne, France. 36. Department of Neuroradiology (F.E.), University Hospital of Rennes, France. 37. Ahepa Hospital, Aristotle University of Thessaloniki, Greece (S.F.).
Abstract
Background and Purpose:
Procedural complications in thrombectomy for large vessel occlusions of the anterior circulation are not well described. We investigated the incidence, risk factors, and clinical implications of thrombectomy complications in daily clinical practice.
Methods:
We used data from the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France. The present study is a retrospective analysis of 4029 stroke patients with anterior large vessel occlusions treated with thrombectomy between January 2015 and May 2020 in 18 centers. We systematically collected procedural data, incidence of embolic complications, perforations and dissections, clinical outcome at 90 days, and hemorrhagic complications.
Results:
Procedural complications occurred in 7.99% (95% CI, 7.17%–8.87%), and embolus to a new territory (ENT) was the most frequent (5.2%). Predictors of ENTs were terminal carotid/tandem occlusion (odds ratio [OR], 5 [95% CI, 2.03–12.31];
P
<0.001) and an increased total number of passes (OR, 1.22 [95% CI, 1.05–1.41];
P
=0.006). ENTs were associated to worse clinical outcomes (90-day modified Rankin Scale score, 0–2; adjusted OR, 0.4 [95% CI, 0.25–0.63];
P
<0.001), increased mortality (adjusted OR, 1.74 [95% CI, 1.2–2.53];
P
<0.001), and symptomatic intracerebral hemorrhage (adjusted OR, 1.87 [95% CI, 1.15–3.03];
P
=0.011). Perforations occurred in 1.69% (95% CI, 1.31%–2.13%). Predictors of perforations were terminal carotid/tandem occlusions (39.7% versus 27.6%;
P
=0.028). 40.7% of patients died at 90 days, and the overall rate of poor outcome was 74.6% in case of perforation. Dissections occurred in 1.46% (95% CI, 1.11%–1.88%) and were more common in younger patients (median age, 64.2 versus 70.2 years;
P
=0.002). Dissections did not affect the clinical outcome at 90 days. Besides dissection, complications were independent of the thrombectomy technique.
Conclusions:
Thrombectomy complication rate is not negligible, and ENTs were the most frequent. ENTs and perforations were associated with disability and mortality, and terminal carotid/tandem occlusions were a risk factor.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03776877.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology
Cited by
31 articles.
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