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Ischemic stroke
Original research
Incidence and outcome of perforations during medium vessel occlusion compared with large vessel occlusion thrombectomy
  1. Victor Schulze-Zachau1,
  2. Alex Brehm1,
  3. Nikolaos Ntoulias1,
  4. Nadja Krug1,
  5. Ioannis Tsogkas1,
  6. Kristine Ann Blackham1,
  7. Markus A Möhlenbruch2,
  8. Jessica Jesser2,
  9. Amedeo Cervo3,
  10. Kornelia Kreiser4,
  11. Katharina Althaus5,
  12. Errikos Maslias6,7,
  13. Patrik Michel6,7,
  14. Guillaume Saliou7,8,
  15. Christoph Riegler9,10,
  16. Christian H Nolte9,10,
  17. Ilko Maier11,
  18. Ala Jamous12,
  19. Riitta Rautio13,
  20. Pauli Ylikotila14,
  21. Kyle M Fargen15,
  22. Stacey Q Wolfe15,
  23. Davide Castellano16,
  24. Andrea Boghi16,
  25. Daniel P O Kaiser17,
  26. Ani Cuberi18,
  27. Jan S Kirschke19,
  28. Julian Schwarting19,
  29. Nicola Limbucci20,
  30. Leonardo Renieri20,
  31. Sami Al Kasab21,
  32. Alejandro M Spiotta21,
  33. Isabel Fragata22,23,
  34. Tania Rodriquez-Ares22,
  35. Christoph Johannes Maurer24,
  36. Ansgar Berlis24,
  37. Manuel Moreu25,
  38. Alfonso López-Frías25,
  39. Carlos Pérez-García25,
  40. Christian Commodaro26,
  41. Marco Pileggi26,
  42. Justin Mascitelli27,
  43. Flavio Giordano28,
  44. Walter Casagrande29,
  45. Cynthia P Purves29,
  46. Maxim Bester30,
  47. Fabian Flottmann30,
  48. Peter T Kan31,
  49. Gautam Edhayan32,
  50. Jeremy Hofmeister33,
  51. Paolo Machi33,
  52. Marius Kaschner34,
  53. Daniel Weiss34,
  54. Mira Katan35,
  55. Urs Fischer35,
  56. Marios-Nikos Psychogios1
  1. 1Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
  2. 2Vascular & Interventional Neuroradiology Section, Minimal Invasive NeuroTherapy Center, University Hospital Heidelberg, Heidelberg, Germany
  3. 3Neuroradiology Department, Niguarda Hospital, Milan, Italy
  4. 4Radiology and Neuroradiology Clinic, RKU - Universitäts- und Rehabilitationskliniken Ulm gGmbH, Ulm, Germany
  5. 5Neurology Clinic, Ulm University Hospital, Ulm, Germany
  6. 6Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  7. 7UNIL - Université de Lausanne, Lausanne, Switzerland
  8. 8Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  9. 9Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
  10. 10Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
  11. 11Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
  12. 12Department of Diagnostic & Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
  13. 13Department of Radiology, Turku University Hospital, Turku, Finland
  14. 14Neurocenter Turku University Hospital, Turku, Finland
  15. 15Neurological Surgery and Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  16. 16Department of Interventional Radiology and Neuroradiology, Ospedale San Giovanni Bosco, Turin, Italy
  17. 17Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
  18. 18Department of Radiology, University Hospital Carl Gustav Carus, Dresden, Germany
  19. 19Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
  20. 20Department of Neurovascular Intervention, Azienda Ospedaliero Universitaria Careggio, Florence, Italy
  21. 21Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  22. 22Department of Neuroradiology, Centro Hospitalar Universitario de Lisboa Central EPE, Lisbon, Portugal
  23. 23NOVA Medical School, Lisbon, Portugal
  24. 24Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
  25. 25Neurointerventional Unit, Radiology Department, Hospital Clinico Universitario San Carlos, Madrid, Spain
  26. 26Diagnostic and Interventional Neuroradiology Department, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
  27. 27Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
  28. 28Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Naples, Italy
  29. 29Neurosurgery Department, Hospital General de Agudos Juan A Fernandez, Buenos Aires, Argentina
  30. 30Diagnostic and Interventional Neuroradiology Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  31. 31Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
  32. 32Department of Radiology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
  33. 33Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
  34. 34Department of Diagnostic and Interventional Radiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
  35. 35Neurology Clinic, University Hospital Basel, Basel, Switzerland
  1. Correspondence to Dr Victor Schulze-Zachau, Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, Universitätsspital Basel, Basel 4031, Switzerland; victor.schulze-zachau{at}posteo.ch

Abstract

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.

  • Thrombectomy
  • Complication
  • Stroke

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.

http://dx.doi.org/10.1136/jnis-2023-020531

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    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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    Footnotes

    • Twitter @daniel_kaiserMD, @schwarting91, @neuroplumber, @PurvesCynthia, @PeterKa80460001, @jhfmstr, @FishingNeurons

    • 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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.