Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study

Author:

Dmytriw Adam A12,Musmar Basel3ORCID,Salim Hamza4ORCID,Ghozy Sherief5,Siegler James E6,Kobeissi Hassan5ORCID,Shaikh Hamza6,Khalife Jane6,Abdalkader Mohamad7,Klein Piers7ORCID,Nguyen Thanh N7ORCID,Heit Jeremy J8,Regenhardt Robert W1ORCID,Cancelliere Nicole M2,Bernstock Joshua D9,Naamani Kareem El10,Amllay Abdelaziz10,Meyer Lukas11,Dusart Anne12,Bellante Flavio12ORCID,Forestier Géraud13ORCID,Rouchaud Aymeric13,Saleme Suzana13,Mounayer Charbel13,Fiehler Jens11,Kühn Anna Luisa14,Puri Ajit S14,Dyzmann Christian15,Kan Peter T16,Colasurdo Marco1617,Marnat Gaultier18ORCID,Berge Jérôme18,Barreau Xavier18,Sibon Igor19,Nedelcu Simona20,Henninger Nils202122,Marotta Thomas R2,Stapleton Christopher J1,Rabinov James D1,Ota Takahiro23ORCID,Dofuku Shogo23ORCID,Yeo Leonard LL24ORCID,Tan Benjamin YQ2425,Gopinathan Anil2425,Martinez-Gutierrez Juan Carlos26,Salazar-Marioni Sergio26ORCID,Sheth Sunil27,Renieri Leonardo27,Capirossi Carolina27,Mowla Ashkan28,Chervak Lina29,Vagal Achala29,Adeeb Nimer3,Cuellar-Saenz Hugo H3,Tjoumakaris Stavropoula I10,Jabbour Pascal10ORCID,Khandelwal Priyank30,Biswas Arundhati31,Clarençon Frédéric3233,Elhorany Mahmoud323334,Premat Kevin3233,Valente Iacopo35,Pedicelli Alessandro35,Filipe João Pedro36,Varela Ricardo36,Quintero-Consuegra Miguel37,Gonzalez Nestor R37ORCID,Möhlenbruch Markus A38ORCID,Jesser Jessica38ORCID,Costalat Vincent39,ter Schiphorst Adrien40,Yedavalli Vivek41,Harker Pablo42,Aziz Yasmin42ORCID,Gory Benjamin4341,Stracke Christian Paul44,Hecker Constantin45,Kadirvel Ramanathan5,Killer-Oberpfalzer Monika45,Griessenauer Christoph J45,Thomas Ajith J6,Hsieh Cheng-Yang46,Liebeskind David S47,Alexandru Radu Răzvan39ORCID,Alexandre Andrea M35,Tancredi Illario48,Faizy Tobias D11ORCID,Fahed Robert49ORCID,Weyland Charlotte38,Lubicz Boris50,Patel Aman B1,Pereira Vitor Mendes2,Guenego Adrien50,

Affiliation:

1. Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

2. Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael’s Hospital, University of Toronto, ON, Canada

3. Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA

4. Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA

5. Department of Neurological Surgery and Radiology, Mayo Clinic, Rochester, MN, USA

6. Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA

7. Departments of Radiology and Neurology, Boston Medical Center, Boston, MA, USA

8. Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA

9. Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA

10. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

11. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

12. Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium

13. University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France

14. Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA

15. Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany

16. Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA

17. Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA

18. Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France

19. Neurology Department, Bordeaux University Hospital, Bordeaux, France

20. Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA

21. Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA

22. Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

23. Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan

24. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

25. Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore

26. Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA

27. Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy

28. Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

29. Department of Neurology and Radiology, University of Cincinnati, Cincinnati, OH, USA

30. Department of Endovascular Neurosurgery and Neuroradiology, Rutgers New Jersey Medical School, Newark, NJ, USA

31. Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA

32. Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France

33. GRC BioFast, Sorbonne University, Paris VI, Paris, France

34. Neurology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

35. UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Florence, Italy

36. Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal

37. Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

38. Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany

39. Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France

40. Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France

41. INSERM U1254, IADI, Université de Lorraine, Vandoeuvre-les-Nancy, France

42. Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA

43. Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France

44. Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany

45. Department of Neurology and Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria

46. Neurology Department, Sin-Lau Hospital, Tainan, Taiwan

47. UCLA Stroke Center and Department of Neurology Department, University of California, Los Angeles, Los Angeles, CA USA

48. Department of Radiology, Hôpital Civil Marie Curie, Charleroi, Belgium

49. Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada

50. Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium

Abstract

Background: Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO. Methods: Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. A total of 1373 AIS patients with MeVO underwent MT. Baseline characteristics, procedural details, and clinical outcomes were analyzed. Results: The incidence of vessel perforation was 4.8% (66/1373). Notably, our analysis indicates variations in perforation rates across different arterial segments: 8.9% in M3 segments, 4.3% in M2 segments, and 8.3% in A2 segments ( p = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, p < 0.001; TICI 2b-3: 56.5% vs 88.3%, p < 0.001). Functional outcomes were also worse in the perforation group (mRS 0–1 at 3 months: 22.7% vs 36.6%, p = 0.031; mRS 0–2 at 3 months: 28.8% vs 53.9%, p < 0.001). Mortality was higher in the perforation group (30.3% vs 16.8%, p = 0.008). Conclusion: This study reveals that while the occurrence of vessel perforation in MT for AIS due to MeVO is relatively rare, it is associated with poor functional outcomes and higher mortality. The findings highlight the need for increased caution and specialized training in performing MT for MeVO. Further prospective research is required for risk mitigation strategies.

Publisher

SAGE Publications

Reference33 articles.

1. Expanding indications for endovascular thrombectomy-how to leave no patient behind

2. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials

3. ANZCTR – Registration. Randomized controlled trial of the clinical outcome and safety of endovascular versus standard medical therapy for stroke with medium sized vessel occlusion. 2023. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001746820p (accessed 13 November 2023).

4. Thrombectomy for Distal, Medium Vessel Occlusions

5. A review of endovascular treatment for medium vessel occlusion stroke

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3