Incidence and outcome of perforations during medium vessel occlusion compared with large vessel occlusion thrombectomy.

Autor:	Schulze-Zachau V; Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland victor.schulze-zachau@posteo.ch., Brehm A; Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland., Ntoulias N; Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland., Krug N; Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland., Tsogkas I; Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland., Blackham KA; Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland., Möhlenbruch MA; Vascular & Interventional Neuroradiology Section, Minimal Invasive NeuroTherapy Center, University Hospital Heidelberg, Heidelberg, Germany., Jesser J; Vascular & Interventional Neuroradiology Section, Minimal Invasive NeuroTherapy Center, University Hospital Heidelberg, Heidelberg, Germany., Cervo A; Neuroradiology Department, Niguarda Hospital, Milan, Italy., Kreiser K; Radiology and Neuroradiology Clinic, RKU - Universitäts- und Rehabilitationskliniken Ulm gGmbH, Ulm, Germany., Althaus K; Neurology Clinic, Ulm University Hospital, Ulm, Germany., Maslias E; Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.; UNIL - Université de Lausanne, Lausanne, Switzerland., Michel P; Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.; UNIL - Université de Lausanne, Lausanne, Switzerland., Saliou G; UNIL - Université de Lausanne, Lausanne, Switzerland.; Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland., Riegler C; Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.; Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany., Nolte CH; Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.; Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany., Maier I; Department of Neurology, University Medical Center Göttingen, Göttingen, Germany., Jamous A; Department of Diagnostic & Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany., Rautio R; Department of Radiology, Turku University Hospital, Turku, Finland., Ylikotila P; Neurocenter Turku University Hospital, Turku, Finland., Fargen KM; Neurological Surgery and Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA., Wolfe SQ; Neurological Surgery and Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA., Castellano D; Department of Interventional Radiology and Neuroradiology, Ospedale San Giovanni Bosco, Turin, Italy., Boghi A; Department of Interventional Radiology and Neuroradiology, Ospedale San Giovanni Bosco, Turin, Italy., Kaiser DPO; Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany., Cuberi A; Department of Radiology, University Hospital Carl Gustav Carus, Dresden, Germany., Kirschke JS; Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany., Schwarting J; Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany., Limbucci N; Department of Neurovascular Intervention, Azienda Ospedaliero Universitaria Careggio, Florence, Italy., Renieri L; Department of Neurovascular Intervention, Azienda Ospedaliero Universitaria Careggio, Florence, Italy., Al Kasab S; Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA., Spiotta AM; Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA., Fragata I; Department of Neuroradiology, Centro Hospitalar Universitario de Lisboa Central EPE, Lisbon, Portugal.; NOVA Medical School, Lisbon, Portugal., Rodriquez-Ares T; Department of Neuroradiology, Centro Hospitalar Universitario de Lisboa Central EPE, Lisbon, Portugal., Maurer CJ; Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany., Berlis A; Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany., Moreu M; Neurointerventional Unit, Radiology Department, Hospital Clinico Universitario San Carlos, Madrid, Spain., López-Frías A; Neurointerventional Unit, Radiology Department, Hospital Clinico Universitario San Carlos, Madrid, Spain., Pérez-García C; Neurointerventional Unit, Radiology Department, Hospital Clinico Universitario San Carlos, Madrid, Spain., Commodaro C; Diagnostic and Interventional Neuroradiology Department, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland., Pileggi M; Diagnostic and Interventional Neuroradiology Department, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland., Mascitelli J; Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA., Giordano F; Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Naples, Italy., Casagrande W; Neurosurgery Department, Hospital General de Agudos Juan A Fernandez, Buenos Aires, Argentina., Purves CP; Neurosurgery Department, Hospital General de Agudos Juan A Fernandez, Buenos Aires, Argentina., Bester M; Diagnostic and Interventional Neuroradiology Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Flottmann F; Diagnostic and Interventional Neuroradiology Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Kan PT; Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA., Edhayan G; Department of Radiology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA., Hofmeister J; Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland., Machi P; Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland., Kaschner M; Department of Diagnostic and Interventional Radiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany., Weiss D; Department of Diagnostic and Interventional Radiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany., Katan M; Neurology Clinic, University Hospital Basel, Basel, Switzerland., Fischer U; Neurology Clinic, University Hospital Basel, Basel, Switzerland., Psychogios MN; Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2024 Jul 16; Vol. 16 (8), pp. 775-780. Date of Electronic Publication: 2024 Jul 16.
DOI:	10.1136/jnis-2023-020531
Abstrakt:	Background: Vessel perforation during thrombectomy is a severe complication and is hypothesized to be more frequent during medium vessel occlusion (MeVO) thrombectomy. The aim of this study was to compare the incidence and outcome of patients with perforation during MeVO and large vessel occlusion (LVO) thrombectomy and to report on the procedural steps that led to perforation. Methods: In this multicenter retrospective cohort study, data of consecutive patients with vessel perforation during thrombectomy between January 1, 2015 and September 30, 2022 were collected. The primary outcomes were independent functional outcome (ie, modified Rankin Scale 0-2) and all-cause mortality at 90 days. Binomial test, chi-squared test and t -test for unpaired samples were used for statistical analysis. Results: During 25 769 thrombectomies (5124 MeVO, 20 645 LVO) in 25 stroke centers, perforation occurred in 335 patients (1.3%; mean age 72 years, 62% female). Perforation occurred more often in MeVO thrombectomy (2.4%) than in LVO thrombectomy (1.0%, p <0.001). More MeVO than LVO patients with perforation achieved functional independence at 3 months (25.7% vs 10.9%, p =0.001). All-cause mortality did not differ between groups (overall 51.6%). Navigation beyond the occlusion and retraction of stent retriever/aspiration catheter were the two most common procedural steps that led to perforation. Conclusions: In our cohort, perforation was approximately twice as frequent in MeVO than in LVO thrombectomy. Efforts to optimize the procedure may focus on navigation beyond the occlusion site and retraction of stent retriever/aspiration catheter. Further research is necessary in order to identify thrombectomy candidates at high risk of intraprocedural perforation and to provide data on the effectiveness of endovascular countermeasures. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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