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

Autor:	Dmytriw AA; Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.; Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, ON, Canada., Musmar B; Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA., Salim H; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA., Ghozy S; Department of Neurological Surgery and Radiology, Mayo Clinic, Rochester, MN, USA., Siegler JE; Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA., Kobeissi H; Department of Neurological Surgery and Radiology, Mayo Clinic, Rochester, MN, USA., Shaikh H; Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA., Khalife J; Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA., Abdalkader M; Departments of Radiology and Neurology, Boston Medical Center, Boston, MA, USA., Klein P; Departments of Radiology and Neurology, Boston Medical Center, Boston, MA, USA., Nguyen TN; Departments of Radiology and Neurology, Boston Medical Center, Boston, MA, USA., Heit JJ; Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA., Regenhardt RW; Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Cancelliere NM; Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, ON, Canada., Bernstock JD; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA., Naamani KE; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA., Amllay A; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA., Meyer L; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Dusart A; Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium., Bellante F; Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium., Forestier G; University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France., Rouchaud A; University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France., Saleme S; University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France., Mounayer C; University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France., Fiehler J; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Kühn AL; Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA., Puri AS; Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA., Dyzmann C; Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany., Kan PT; Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA., Colasurdo M; Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA.; Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA., Marnat G; Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France., Berge J; Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France., Barreau X; Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France., Sibon I; Neurology Department, Bordeaux University Hospital, Bordeaux, France., Nedelcu S; Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA., Henninger N; Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.; Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA.; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA., Marotta TR; Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, ON, Canada., Stapleton CJ; Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Rabinov JD; Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Ota T; Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan., Dofuku S; Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan., Yeo LL; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Tan BY; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.; Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore., Gopinathan A; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.; Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore., Martinez-Gutierrez JC; Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA., Salazar-Marioni S; Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA., Sheth S; Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy., Renieri L; Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy., Capirossi C; Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy., Mowla A; Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA., Chervak L; Department of Neurology and Radiology, University of Cincinnati, Cincinnati, OH, USA., Vagal A; Department of Neurology and Radiology, University of Cincinnati, Cincinnati, OH, USA., Adeeb N; Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA., Cuellar-Saenz HH; Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA., Tjoumakaris SI; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA., Jabbour P; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA., Khandelwal P; Department of Endovascular Neurosurgery and Neuroradiology, Rutgers New Jersey Medical School, Newark, NJ, USA., Biswas A; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA., Clarençon F; Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.; GRC BioFast, Sorbonne University, Paris VI, Paris, France., Elhorany M; Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.; GRC BioFast, Sorbonne University, Paris VI, Paris, France.; Neurology Department, Faculty of Medicine, Tanta University, Tanta, Egypt., Premat K; Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.; GRC BioFast, Sorbonne University, Paris VI, Paris, France., Valente I; UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Florence, Italy., Pedicelli A; UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Florence, Italy., Filipe JP; Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal., Varela R; Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal., Quintero-Consuegra M; Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Gonzalez NR; Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Möhlenbruch MA; Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany., Jesser J; Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany., Costalat V; Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France., Ter Schiphorst A; Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France., Yedavalli V; INSERM U1254, IADI, Université de Lorraine, Vandoeuvre-les-Nancy, France., Harker P; Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA., Aziz Y; Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA., Gory B; Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.; INSERM U1254, IADI, Université de Lorraine, Vandoeuvre-les-Nancy, France., Stracke CP; Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany., Hecker C; Department of Neurology and Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria., Kadirvel R; Department of Neurological Surgery and Radiology, Mayo Clinic, Rochester, MN, USA., Killer-Oberpfalzer M; Department of Neurology and Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria., Griessenauer CJ; Department of Neurology and Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria., Thomas AJ; Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA., Hsieh CY; Neurology Department, Sin-Lau Hospital, Tainan, Taiwan., Liebeskind DS; UCLA Stroke Center and Department of Neurology Department, University of California, Los Angeles, Los Angeles, CA USA., Alexandru Radu R; Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France., Alexandre AM; UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Florence, Italy., Tancredi I; Department of Radiology, Hôpital Civil Marie Curie, Charleroi, Belgium., Faizy TD; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Fahed R; Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada., Weyland C; Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany., Lubicz B; Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium., Patel AB; Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Pereira VM; Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, ON, Canada., Guenego A; Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.
Jazyk:	angličtina
Zdroj:	European stroke journal [Eur Stroke J] 2024 Jun; Vol. 9 (2), pp. 328-337. Date of Electronic Publication: 2024 Feb 26.
DOI:	10.1177/23969873231219412
Abstrakt:	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. Competing Interests: Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Regenhardt serves on a DSMB for a trial sponsored by Rapid Medical, serves as site PI for studies sponsored by Penumbra and Microvention, and receives stroke research grant funding from the National Institutes of Health, Society of Vascular and Interventional Neurology, and Heitman Stroke Foundation. Dr. Guenego reports consultancy for Rapid Medical and Phenox, not directly related to the present work. Prof. Clarençon reports conflicts of interest with Medtronic, Balt Extrusion (consultant), ClinSearch (core lab), Penumbra, Stryker (payment for reading), and Artedrone (Board); all not directly related to the present work. Dr. Henninger received support from NINDS NS131756, during the conduct of the study. Dr. Liebeskind is consultant as Imaging Core Lab to Cerenovus, Genentech, Medtronic, Stryker, Rapid Medical. Dr. Nguyen reports advisory board with Idorsia. Dr. Yeo reports Advisory work for AstraZeneca, Substantial support from NMRC Singapore and is a medical advisor for See-mode, Cortiro, and Sunbird Bio, with equity in Ceroflo. All unrelated to the present work. Dr. Griessenauer reports a proctoring agreement with Medtronic and research funding by Penumbra. Dr. Marnat reports conflicts of interest with Microvention Europe, Stryker Neurovascular, Balt (consulting), Medtronic, Johnson & Johnson, and Phenox (paid lectures), all not directly related to the present work. Pr Sibon reports conflict of interest with Medtronic, Sanofi, Bayer, Boehringer-Ingelheim, Novartis, Novo-Nordisk, BMS-Pfizer (board and paid lectures), all not directly related to the present work. Dr. Yedavalli is a consultant for RAPID (Ischemaview, Menlo Park, CA). Dr. Vagal is a consultant for Viz AI. She is also PI of Imaging core lab for ENDOLOW study funded by Cerenovus (monies go to the institution). Dr. Gopinathan reports conflicts of interest with Microvention, Stryker Neurovascular, Medtronic, BD, Penumbra (paid lectures, workshops, and proctoring), all not directly related to the present work. Dr. Bernstock has an equity position in Treovir Inc., an oHSV clinical stage company and UpFront Diagnostics. JDB is also on the Centile Bioscience and NeuroX1 boards of scientific advisors.
Databáze:	MEDLINE
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