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Vessel perforation during stent retriever thrombectomy for acute ischemic stroke: technical details and clinical outcomes
  1. Maxim Mokin1,
  2. Kyle M Fargen2,
  3. Christopher T Primiani1,
  4. Zeguang Ren1,
  5. Travis M Dumont3,
  6. Leonardo B C Brasiliense3,
  7. Guilherme Dabus4,
  8. Italo Linfante4,
  9. Peter Kan5,
  10. Visish M Srinivasan5,
  11. Mandy J Binning6,
  12. Rishi Gupta7,
  13. Aquilla S Turk8,
  14. Lucas Elijovich9,
  15. Adam Arthur9,
  16. Hussain Shallwani10,
  17. Elad I Levy10,
  18. Adnan H Siddiqui10
  1. 1Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
  2. 2Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
  3. 3Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona, USA
  4. 4Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, Florida, USA
  5. 5Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  6. 6Drexel Neurosciences Institute, Philadelphia, Pennsylvania, USA
  7. 7Wellstar Neurosurgery, Marietta, Georgia, USA
  8. 8Medical University of South Carolina, Charleston, South Carolina, USA
  9. 9Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  10. 10Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
  1. Correspondence to Dr Maxim Mokin, University of South Florida Neurosurgery, 2 Tampa General Circle, 7th floor, Tampa, FL 33606, USA; maximmokin{at}gmail.com

Abstract

Background Vessel perforation during stent retriever thrombectomy is a rare complication; typically only single instances have been reported.

Objective To report on a series of patients whose stent retriever thrombectomy was complicated by intraprocedural vessel perforation and discuss its potential mechanisms, rescue treatment strategies, and clinical significance.

Methods Cases with intraprocedural vessel perforation, where a stent retriever was used either as a primary treatment approach or as a part of a direct aspiration first pass technique (ADAPT), were included in the final analysis. Clinical data, procedural details, radiographic and clinical outcomes were collected from nine participating centers.

Results Intraprocedural vessel perforation during stent retriever thrombectomy occurred in 16 (1.0%) of 1599 cases. 63% of intraprocedural perforations occurred at distal locations. Endovascular rescue techniques (most commonly, intracranial balloon occlusion for tamponade) were attempted in 50% of cases. Procedure was aborted without any rescue attempts in 44% of cases. Mortality during hospitalization and at 3 months was 56% and 63%, respectively. 25% of patients achieved good functional outcome at 3 months after the procedure.

Conclusions Intraprocedural perforations during stent retriever thrombectomy were rare, but when they occurred were associated with high mortality. Perforations most commonly occurred at distal occlusion sites and were often characterized by difficulty traversing the occlusion with a microcatheter or microwire, or while withdrawing the stent retriever. Nevertheless, 25% of patients had a favorable functional outcome, suggesting that in some patients with this complication good neurological recovery is achievable.

  • Stroke
  • Subarachnoid
  • Thrombectomy
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