Introduction Cerebral arterial thrombectomy for the treatment of acute ischemic stroke has been available in the United States outside clinical trials for the past decade. One component that has evolved only modestly over this period is the reliance upon the balloon guide catheter (BGC). Use of these catheters has been associated with higher rates of recanalization and better clinical outcomes in comparison to stent retriever thrombectomy without the use of a BGC. Increased utilization of BGCs raises the concern for large-bore sheaths causing vascular groin complications in this subset of patients. We aimed to retrospectively evaluate the impact of large sheath sizes and vascular closure devices on groin complications, in a high-volume neurointerventional center.
Materials and methods We retrospectively assessed groin complication rates at a comprehensive stroke center over a ten-year period. The clinical records of patients who underwent mechanical endovascular therapy with an 8Fr or larger BGC, between January 1st 2005 and December 31st 2014, were reviewed from our neuro-interventional patient database. Information collected included size of sheath, type of vascular closure device used and anticoagulation status of the patient. Blood bank records were analyzed to identify patients who may have had a blood transfusion for a groin hematoma during their admission for stroke treatment. Radiological reports were reviewed for evidence of ultrasound imaging of the groin or CT of the abdomen and pelvis, up to thirty days post-procedure. Clinical records were also examined for descriptions of complications at the groin site. Groin complications were sub-classified into ‘definite’ or ‘possible’.
Results A total of 472 patients with acute ischemic stroke who underwent mechanical thrombectomy with a sheath and balloon guide catheter sized 8Fr or larger were identified. The mean age ± SD was 70 ± 16 years, and 50% were female. 448 patients (95%) were treated using an 8Fr sheath and balloon guide catheter and 24 patients (5%) had a 9Fr sheath and balloon guide catheter used. Vascular closure devices were used in 96.8% of cases (n = 457), with the Angioseal being the most common (n = 457, 96.8%).
A very small number of patients were identified (n = 2, 0.4%) who had clinically significant, definite vascular groin complications associated with the use of an 8Fr sheath and BGC. One patient had a pseudoaneurysm that required thrombin injection, while the second patient developed a hematoma that required blood transfusion.
Two additional patients were identified from blood bank records who had blood transfusions within 48 h of groin puncture with no mention of groin hematoma or bleeding described in the clinical notes. Neither patient had imaging of the groin performed post procedure; as such, these patients were classified as possible groin complications. The complication rate encompassing both ‘definite’ and possible’ complications was therefore 0.8% (n = 4).
There were no retroperitoneal hematomas requiring transfusion or intervention. There were no deaths attributed to groin complications.
Conclusions In our series, the low groin complication rate (0.4%-0.8%) in thrombectomy suggests that concerns for vascular complications should not preclude the use of BGCs in the endovascular treatment of ischemic stroke.
Disclosures V. Shah: None. C. Martin: None. A. Hawkins: None. W. Holloway: None. S. Junna: None. N. Akhtar: None.
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