Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke-Reference-Cited by-同舟云学术

Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke

Published:2020-12-06 Issue:7 Volume:16 Page:818-827
ISSN:1747-4930
Container-title:International Journal of Stroke
language:en
Short-container-title:International Journal of Stroke

Author:

Salsano Giancarlo¹^ORCID,Pracucci Giovanni²,Mavilio Nicola¹,Saia Valentina³,Bandettini di Poggio Monica⁴^ORCID,Malfatto Laura¹,Sallustio Fabrizio⁵,Wlderk Andrea⁵,Limbucci Nicola⁶,Nencini Patrizia⁶,Vallone Stefano⁷,Zini Andrea⁸^ORCID,Bigliardi Guido⁷,Velo Mariano⁹,Francalanza Isabella⁹^ORCID,Gennari Paola¹⁰,Tassi Rossana¹⁰,Bergui Mauro¹¹,Cerrato Paolo¹¹,Carità Giuseppe¹²,Azzini Cristiano¹²,Gasparotti Roberto¹³,Magoni Mauro¹³,Isceri Salvatore⁸,Commodaro Christian¹⁴,Cordici Francesco¹⁴,Menozzi Roberto¹⁵,Latte Lilia¹⁵,Cosottini Mirco¹⁶,Mancuso Michelangelo¹⁶,Comai Alessio¹⁷,Franchini Enrica¹⁷,Alexandre Andrea¹⁸^ORCID,Marca Giacomo Della¹⁸,Puglielli Edoardo¹⁹,Casalena Alfonsina¹⁹,Causin Francesco²⁰,Baracchini Claudio²⁰,Di Maggio Luca²¹,Naldi Andrea²¹,Grazioli Andrea²²,Forlivesi Stefano²²,Chiumarulo Luigi²³,Petruzzellis Marco²³,Sanfilippo Giuseppina²⁴^ORCID,Toscano Gianpaolo²⁴,Cavasin Nicola²⁵,Adriana Critelli²⁵,Ganimede Maria Porzia²⁶,Prontera Maria Pia²⁶,Andrea Giorgianni²⁷,Mauri Marco²⁷,Auteri William²⁸,Petrone Alfredo²⁸,Cirelli Carlo²⁹,Falcou Anne²⁹,Corraine Simona³⁰,Piras Valeria³⁰,Ganci Giuseppe³,Tassinari Tiziana³,Nuzzi Nunzio Paolo³¹,Corato Manuel³¹,Sacco Simona³²^ORCID,Squassina Guido¹³,Invernizzi Paolo¹³,Gallesio Ivan³³,Ferrandi Delfina³³,Dui Giovanni³⁴,Deiana Gianluca³⁴,Amistà Pietro³⁵,Russo Monia³⁵,Pintus Francesco³⁶,Baule Antonio³⁶,Craparo Giuseppe³⁷,Mannino Marina³⁷,Castellan Lucio¹,Toni Danilo³⁸,Mangiafico Salvatore⁶

Affiliation:

1. IRCCS San Martino Policlinic Hospital, Neuroradiology and Neurology, Genoa, Italy

2. Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy

3. Neuroradiology Unit and Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy

4. IRCCS San Martino Policlinic Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genoa, Italy

5. Imaging and Interventional Radiology and Stroke Unit, Policlinico Tor Vergata, Roma, Italy

6. Interventional Neurovascular Unit and Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy

7. Neuroradiology and Neurology, Ospedale Civile S. Agostino-Estense, University Hospital, Modena, Italy

8. IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center and Neuroradiology, Maggiore Hospital, Bologna, Italy

9. Neuroradiology and Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Policlinico G. Martino Messina, Italy

10. Neuroradiology and Neurology, AOU Senese, Siena, Italy

11. Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy

12. Neuroradiology and Neurology, Arcispedale S. Anna-University Hospital, Ferrara, Italy

13. Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy

14. Department of Neuroradiology, Neurology and Stroke Unit, Cesena-Forlì, AUSL Romagna Azienda Ospedaliera, Cesena, Italy

15. Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy

16. Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

17. Radiology Unit and Stroke Unit, Ospedale Centrale, Bolzano, Italy

18. Institute of Neuroradiology and Neurology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy

19. Ospedale Civile Mazzini, Teramo, Italy

20. Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Padua, Italy

21. Neuroradiology and Neurology, Ospedale San Giovanni Bosco, Torino, Italy

22. UOC Neuroradiologia, DAI Patologia e Diagnostica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

23. Interventional Neuroradiology Unit and Stroke Unit, Policlinico, Bari, Italy

24. Diagnostic and Interventional Neuroradiology Unit and Stroke Unit, IRCCS Mondino Foundation San Matteo Hospital, Pavia, Italy

25. Neuroradiology Unit and Neurology Unit, Ospedale dell’Angelo, USSL3 Serenissima, Mestre, Italy

26. Interventional Radiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy

27. Neuroradiology Unit and Stroke Unit, Ospedale Universitario Circolo, ASST Sette Laghi, Varese, Italy

28. Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy

29. Department of Human Neurosciences, Interventional Neuroradiology and Neurology, Università degli Studi di Roma Sapienza, Roma, Lazio, Italy

30. Neuroscience Department, Azienda Ospedaliera G. Brotzu, Cagliari, Sardinia, Italy

31. IRCCS Humanitas Clinical and Research Center, Rozzano, Milano, Italy

32. Department of Clinical Scieces and Biotechnology, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy

33. Department of Radiology and Neuroradiological Unit, Department of Neurology, Azienda ospedaliera “SS Antonio e Biagio e C. Arrigo,” Alessandria, Italy

34. Radiology and Interventional Radiology Unit and Neurology Unit, Ospedale San Francesco, Nuoro, Italy

35. Department of Neuroradiology and Neurology, Hospital of Rovigo, Rovigo, Italy

36. Unit of Neuroradiology and Stroke Unit, Santissima Annunziata Hospital, Sassari, Italy

37. Department of Neuroradiology and Neurology, AOOR Villa Sofia-V. Cervello, Palermo, Italy

38. Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy

Abstract

Background There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes. Aims We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications. Methods From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected. Results The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21–2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13–8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66–12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31–0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97–0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19–0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6–0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02–1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02–1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25–2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26–3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08–2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55–0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up. Conclusions Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits.

Publisher

SAGE Publications

Subject

Neurology

Link

http://journals.sagepub.com/doi/pdf/10.1177/1747493020976681

Reference19 articles.

1. The Italian Registry of Endovascular Treatment in Acute Stroke: rationale, design and baseline features of patients

2. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies

3. Complications of endovascular treatment for acute ischemic stroke: Prevention and management

4. Endovascular treatment for acute ischaemic stroke with large vessel occlusion: the experience of a regional stroke service

5. Subarachnoid Hemorrhage in a Multimodal Approach Heavily Weighted Toward Mechanical Thrombectomy With Solitaire Stent in Acute Stroke

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