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  • P137/17  Incidence and outcome of perforations occuring during Medium-Vessel Occlusion thrombectomy compared to Large-Vessel occlusion thrombectomy

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2.3 ISCHEMIC – Treatment
P137/17  Incidence and outcome of perforations occuring during Medium-Vessel Occlusion thrombectomy compared to Large-Vessel occlusion thrombectomy
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  1. Victor Schulze-Zachau1,
  2. Alex Brehm1,
  3. Nikolaos Ntoulias1,
  4. Nadja Krug1,
  5. Ioannis Tsogkas2,
  6. Kristine Blackham2,
  7. Markus Möhlenbruch3,
  8. Jessica Jesser3,
  9. Amedeo Cervo4,
  10. Kornelia Kreiser5,
  11. Katharina Althaus5,
  12. Errikos Maslias6,
  13. Patrik Michel6,
  14. Guillaume Saliou6,
  15. Christoph Riegler7,
  16. Christian Nolte7,
  17. Ilko Maier8,
  18. Ala Jamous8,
  19. Riitta Rautio9,
  20. Pauli Ylikotila9,
  21. Kyle Fargen10,
  22. Stacey Wolfe10,
  23. Davide Castellano11,
  24. Andrea Boghi11,
  25. Daniel Kaiser12,
  26. Ani Cuberi12,
  27. Jan Kirschke13,
  28. Julian Schwarting13,
  29. Nicola Limbucci14,
  30. Leonardo Renieri14,
  31. Sami Al Kasab15,
  32. Alejandro Spiotta15,
  33. Isabel Fragata16,
  34. Tania Rodríguez-Ares16,
  35. Christoph Maurer17,
  36. Berlis Ansgar17,
  37. Manuel Moreu18,
  38. Alfonso López-Frías López-Jurado18,
  39. Carlos Pérez-García18,
  40. Christian Commodaro19,
  41. Marco Pileggi19,
  42. Justin Mascitelli20,
  43. Flavio Giordano21,
  44. Walter Casagrande22,
  45. Cynthia Purves22,
  46. Maxim Bester23,
  47. Fabian Flottmann23,
  48. Peter Kan24,
  49. Gautam Edhayan24,
  50. Jeremy Hofmeister25,
  51. Paolo Machi25,
  52. Marius Kaschner26,
  53. Daniel Weiss26,
  54. Mira Katan2,
  55. Urs Fischer2,
  56. Marios Psychogios1
  1. 1University Hospital Basel, Department of Diagnostic and Interventional Neuroradiology, Basel, Switzerland
  2. 2University Hospital Basel, Basel, Switzerland
  3. 3Heidelberg University Hospital, Heidelberg, Germany
  4. 4Niguarda Hospital, Milano, Italy
  5. 5University and Rehabilitation Clinic Ulm, Ulm, Germany
  6. 6Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
  7. 7Charité Universitätsmedizin Berlin, Berlin, Germany
  8. 8University Medicine Göttingen, Göttingen, Germany
  9. 9Turku University Hospital, Turku, Finland
  10. 10Wake Forest University, Winston-Salem, USA
  11. 11S. Giovanni Bosco Hospital, Turin, Italy
  12. 12University Hospital Carl Gustav Carus Dresden, Dresden, Germany
  13. 13Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
  14. 14Ospedale Careggi di Firenze, Florence, Italy
  15. 15Medical University of South Carolina, Charleston, USA
  16. 16Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
  17. 17University Hospital Augsburg, Augsburg , Germany
  18. 18Hospital Clínico Universitario San Carlos, Madrid, Spain
  19. 19Neurocenter of Southern Switzerland, Lugano, Switzerland
  20. 20University of Texas Health Sciences Center at San Antonio , San Antonio, USA
  21. 21Dipartimento delle Tecnologie Avanzate Diagnostico-Terapeutiche e dei Servizi sanitary, A.O.R.N. Cardarelli, Naples, Italy
  22. 22Hospital General de Agudos “Juan A. Fernández’, Buenos Aires, Argentina
  23. 23University Hospital Eppendorf, Hamburg, Germany
  24. 24University of Texas Medical Branch, Galveston, USA
  25. 25Geneva University Hospital, Geneva, Switzerland
  26. 26University Düsseldorf, Düsseldorf, Germany

Abstract

Introduction Vessel perforation during thrombectomy is a severe complication and is hypothesized to be more frequent during MeVO compared to LVO thrombectomy.

Aim of the study To compare the incidence and outcome of patients with perforation during MeVO and 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 01, 2015 and September 30, 2022 were collected. The primary outcomes were independent functional outcome (i.e. 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 (5,124 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 three months (25.7% vs 10.9%; p=0.001). All-cause mortality did not differ (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. Considering the rather benign natural course of MeVO stroke, physicians should be avoiding perforation during MeVO thrombectomy by all means. Efforts to optimize the procedure may focus on navigation beyond the occlusion site and retraction of stent-retriever/aspiration catheter.

Disclosure of Interest Nothing to disclose

http://dx.doi.org/10.1136/jnis-2023-ESMINT.165

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