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Abstracts
Ischemic
2.3. Treatment
O36 Insights into vessel perforations during thrombectomy: characteristics of a severe complication and effect of thrombolysis
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  1. Victor Schulze-Zachau1,
  2. Nikki Rommers2,
  3. Nikolaos Ntoulias2,
  4. Alex Brehm3,
  5. Nadja Krug4,
  6. Ioannis Tsogkas4,
  7. Matthias Mutke4,
  8. Thilo Rusche4,
  9. Amedeo Cervo5,
  10. Claudia Rollo5,
  11. Markus Moehlenbruch6,
  12. Jessica Jesser6,
  13. Katharina Althaus7,
  14. Manuel Requena8,
  15. Marc Rodrigo-Gisbert9,
  16. Tomas Dobrocky10,
  17. Bettina Serallach10,
  18. Christian Nolte11,
  19. Christoph Riegler11,
  20. Jawed Nawabi12,
  21. Errikos Maslias13,
  22. Patrik Michel13,
  23. Guillaume Saliou14,
  24. Nathan Manning15,
  25. Alexander McQuinn15,
  26. Alon Taylor16,
  27. Christoph Maurer17,
  28. Berlis Ansgar17,
  29. Daniel Kaiser18,
  30. Ani Cuberi19,
  31. Manuel Moreu20,
  32. Alfonso López-Frías López-Jurado20,
  33. Carlos Pérez-García20,
  34. Riitta Rautio21,
  35. Pauli Ylikotila21,
  36. Nicola Limbucci22,
  37. Leonardo Renieri22,
  38. Isabel Fragata23,
  39. Tania Rodríguez-Ares24,
  40. Jan Kirschke25,
  41. Julian Schwarting25,
  42. Sami Al Kasab26,
  43. Alejandro Spiotta26,
  44. Ahmad Abu Qdais27,
  45. Adam Dmytriw28,29,
  46. Robert Regenhardt30,
  47. Aman Patel30,
  48. Vitor Mendes Pereira29,
  49. Nicole Cancelliere29,
  50. Carsten Schmeel31,
  51. Franziska Dorn31,
  52. Malte Sauer31,
  53. Grzegorz Karwacki32,
  54. Jane Khalife33,
  55. Ajith Thomas34,
  56. Hamza Shaikh35,
  57. Christian Commodaro36,
  58. Marco Pileggi36,
  59. Roland Schwab37,
  60. Flavio Bellante38,
  61. Anne Dusart38,
  62. Jeremy Hofmeister39,
  63. Paolo MacHi39,
  64. Edgar Samaniego40,41,42,
  65. Diego Ojeda42,
  66. Robert Starke43,
  67. Ahmed Abdelsalam43,
  68. Frans van den Bergh44,
  69. Sylvie De Raedt45,
  70. Maxim Bester46,
  71. Fabian Flottmann,
  72. Daniel Weiss47,
  73. Marius Kaschner47,
  74. Peter Kan48,
  75. Gautam Edhayan48,
  76. Michael Levitt49,
  77. Spencer Raub50,
  78. Mira Katan51,
  79. Urs Fischer51,
  80. Marios Psychogios52
  1. 1University Hospital Basel, Diagnostic and Interventional Neuroradiology Department, Basel, Switzerland
  2. 2, Basel, Switzerland
  3. 3Department of Diagnostic and Interventional Neuroradiology, Radiology and Nuclear Medicine Clinic, Clinical Research Department, University Basel, Basel, Switzerland
  4. 4Department of Diagnostic and Interventional Neuroradiology, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
  5. 5Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Milano, Italy
  6. 6Vascular and Interventional Neuroradiology Section, Minimal Invasive NeuroTherapy Center, Heidelberg University Hospital, Heidelberg, Germany
  7. 7Neurology Clinic, University Hospital Ulm, Ulm, Germany
  8. 8Interventional Neuroradiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
  9. 9Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
  10. 10Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
  11. 11Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Center for Stroke Research Berlin (CSB) and Berlin Institute of Healths (BIH), Charité Universitätsmedizin, Berlin, Germany
  12. 12Department of Neuroradiology, Charité – Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany
  13. 13Stroke Center, Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
  14. 14Interventional Neuroradiological Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
  15. 15Department of Interventional Radiology, Liverpool Hospital, Neurointervention and Neurovascular Clinic, Prince of Wales Hospital, Sydney, Australia
  16. 16Neurointervention and Neurovascular Clinic, Prince of Wales Hospital, Sydney, Australia
  17. 17Department of Diagnostic and Interventional Neuroradiology, Augsburg University Hospital, Augsburg, Germany
  18. 18Department of Neuroradiology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
  19. 19Department of Radiology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
  20. 20Neurointerventional Unit, Radiology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
  21. 21Department of Interventional Radiology, Turku University Hospital, Finland, Turku, Finland
  22. 22Department of Neurovascular Intervention, Ospedale Careggi di Firenze, Florence, Italy
  23. 23NOVA Medical School, Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
  24. 24Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
  25. 25Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
  26. 26Department of Neurosurgery, Medical University of South Carolina, Charleston/South Carolina, USA
  27. 27Department of Neurology, Medical University of South Carolina, Charleston/South Carolina, USA
  28. 28Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
  29. 29Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada
  30. 30Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women’s Hospital, Harvard Medical School, Boston/Massachusetts, USA
  31. 31Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
  32. 32Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, Luzern, Switzerland
  33. 33Department of Neurology, Cooper Neurological Institute, Camden/New Jersey, USA
  34. 34Department of Neurosurgery, Cooper Neurological Institute, Camden/New Jersey, USA
  35. 35Department of Neurointerventional Surgery, Cooper Neurological Institute, Camden/New Jersey, USA
  36. 36Department of Diagnostic and Interventional Neuroradiology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
  37. 37University Clinic for Neuroradiology, Medical Faculty, Otto-Von-Guericke-University, Magdeburg, Germany
  38. 38Service de Neurologie, CHU de Charleroi, Charleroi, Belgium
  39. 39Service of Diagnostic and Interventional Neuroradiology, Geneva University Hospital, Geneva, Switzerland
  40. 40Department of Neurology, University of Iowa, College of Medicine, Iowa City/Iowa, USA
  41. 41Department of Neurosurgery, University of Iowa, College of Medicine, Iowa City/Iowa, USA
  42. 42University of Iowa, College of Medicine, Iowa City/Iowa, USA
  43. 43Miami Miller School of Medicine, Jackson Memorial Hospital, University of Miami Hospital, Miami/Florida, USA
  44. 44Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
  45. 45Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
  46. 46Department of Neuroradiology, University Hospital Eppendorf, Hamburg, Germany
  47. 47Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
  48. 48Department of Neurosurgery, University of Texas Medical Branch, Galveston/Texas, USA
  49. 49Department of Neurosurgery, University of Washington, Seattle/Washington, USA
  50. 50Department of Neurosurgery, University of Washington, Seattle/Washington, USA
  51. 51Neurology Clinic, University Hospital Basel, Clinical Research Department, University Basel, Basel, Switzerland
  52. 52Department of Diagnostic and Interventional Neuroradiology, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Clinical Research Department, University Basel, Basel, Switzerland

Abstract

Introduction Complications associated with thrombectomy remain poorly explored1-5.

Aim of Study To characterize periprocedural vessel perforation and to assess the effect of thrombolysis on patient outcomes.

Methods In this multicenter retrospective cohort study, consecutive patients with vessel perforation during thrombectomy between January 2015 and April 2023 were included. Vessel perforation was defined as contrast extravasation on digital subtraction angiography. The primary outcome was modified Rankin Scale (mRS) at 90 days. Factors associated with the primary outcome were assessed using proportional odds models.

Results 459 patients with vessel perforation were included (72.5 ± 13.6 years, 59% female, 41% received thrombolysis). Mortality at 90 days was 51.9% and 16.3% of patients reached mRS 0-2 at 90 days. Thrombolysis was not associated with worse outcome at 90 days. Perforation of a large vessel (LV) as opposed to medium/distal vessel (MDV) perforation was independently associated with worse outcome at 90 days (aOR 1.709, p=0.04) and LV perforation was associated with poorer survival probability (HR 1.389, p=0.021). Patients with active bleeding >20 minutes had worse survival probability (HR 1.797, p=0.009). Thrombolysis was not associated with longer bleeding duration. Bleeding cessation was achieved faster by permanent vessel occlusion compared to temporary measures (median difference: 4 minutes, p<0.001).

Conclusion Vessel perforation during thrombectomy is a severe and frequently fatal complication. Thrombolysis does not significantly attribute to worse prognosis. Outcome and survival after LV perforation is worse compared to MDV perforation. Cessation of active bleeding within 20 minutes is critical, emphasizing the need for interventionalists to be trained in complication management.

Abstract O36 Figure 1
Abstract O36 Figure 1
Abstract O36 Figure 2
Abstract O36 Figure 2

Disclosure of Interest yes V. S.-Z. discloses speaker fees from Medtronic Inc. (money paid to institution). M.R.L. discloses unrestricted educational grants from Medtronic and Stryker; consulting for Medtronic, Stereotaxis, Metis Innovative and Aeaean Advisers; equity interest in Proprio, Fluid Biomed, Stroke Diagnostics, Hyperion Surgical, Apertur; editorial board of Journal of NeuroInterventional Surgery; data safety monitoring board of Arsenal Medical. M.-N.P. discloses unrestricted grants from Swiss National Science Foundation (SNF), Bangerter-Rhyner Stiftung, Stryker Neurovascular Inc., Phenox GmbH, Medtronic Inc., Rapid Medical Inc., and Penumbra Inc for the DISTAL trial, grant for SPINNERS trial from Siemens Healthineers AG (money paid to institution) and the following speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Rapid Medical Inc. and Siemens Healthineers AG (money paid to institution).

https://doi.org/10.1136/jnis-2024-ESMINT.36

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