Background Vessel perforation during thrombectomy is a severe complication and is hypothesized to be more frequent during medium vessel occlusion (MeVO) thrombectomy. The aim of this study was to compare the incidence and outcome of patients with perforation during MeVO and large vessel occlusion (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 1, 2015 and September 30, 2022 were collected. The primary outcomes were independent functional outcome (ie, 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 (5124 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 3 months (25.7% vs 10.9%, p=0.001). All-cause mortality did not differ between groups (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. Efforts to optimize the procedure may focus on navigation beyond the occlusion site and retraction of stent retriever/aspiration catheter. Further research is necessary in order to identify thrombectomy candidates at high risk of intraprocedural perforation and to provide data on the effectiveness of endovascular countermeasures.
Data availability statement
Data are available upon reasonable request. Data availability statement: Deidentified participant data are available upon reasonable request from the corresponding author for purposeful quality improvement projects.
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Contributors VS-Z had the idea for the study, monitored data collection, collected data, designed the analysis plan, cleaned, analyzed and interpreted the data, and drafted and revised the manuscript. He is guarantor. AB designed the analysis plan, revised the manuscript and approved the final version to be published. NN and NK collected data, cleaned the data, revised the manuscript and approved the final version to be published. IT and KAB cleaned the data, revised the manuscript and approved the final version to be published. MAM, JJ, AC, KK, KA, EM, PM, GS, CR, CHN, IM, AJ, RR, PY, KMF, SQW, DC, AB, DPOK, AC, JSK, JS, NL, LR, SAK, AMS, IF, TR-A, CJM, AB, MM, AL-F, CP-G, CC, MP, JM, FG, WC, CPP, MB, FF, PTK, GE, JH, PM, MK and DW collected data, revised the manuscript and approved the final version to be published. MK and UF interpreted the data, revised the manuscript and approved the final version to be published. M-NP had the idea for the study, designed the analysis plan, interpreted the data, revised the manuscript and approved the final version to be published. He is guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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