RT Journal Article
SR Electronic
T1 Vessel perforation during stent retriever thrombectomy for acute ischemic stroke: technical details and clinical outcomes
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 922
OP 928
DO 10.1136/neurintsurg-2016-012707
VO 9
IS 10
A1 Maxim Mokin
A1 Kyle M Fargen
A1 Christopher T Primiani
A1 Zeguang Ren
A1 Travis M Dumont
A1 Leonardo B C Brasiliense
A1 Guilherme Dabus
A1 Italo Linfante
A1 Peter Kan
A1 Visish M Srinivasan
A1 Mandy J Binning
A1 Rishi Gupta
A1 Aquilla S Turk
A1 Lucas Elijovich
A1 Adam Arthur
A1 Hussain Shallwani
A1 Elad I Levy
A1 Adnan H Siddiqui
YR 2017
UL http://jnis.bmj.com/content/9/10/922.abstract
AB Background Vessel perforation during stent retriever thrombectomy is a rare complication; typically only single instances have been reported.Objective To report on a series of patients whose stent retriever thrombectomy was complicated by intraprocedural vessel perforation and discuss its potential mechanisms, rescue treatment strategies, and clinical significance.Methods Cases with intraprocedural vessel perforation, where a stent retriever was used either as a primary treatment approach or as a part of a direct aspiration first pass technique (ADAPT), were included in the final analysis. Clinical data, procedural details, radiographic and clinical outcomes were collected from nine participating centers.Results Intraprocedural vessel perforation during stent retriever thrombectomy occurred in 16 (1.0%) of 1599 cases. 63% of intraprocedural perforations occurred at distal locations. Endovascular rescue techniques (most commonly, intracranial balloon occlusion for tamponade) were attempted in 50% of cases. Procedure was aborted without any rescue attempts in 44% of cases. Mortality during hospitalization and at 3 months was 56% and 63%, respectively. 25% of patients achieved good functional outcome at 3 months after the procedure.Conclusions Intraprocedural perforations during stent retriever thrombectomy were rare, but when they occurred were associated with high mortality. Perforations most commonly occurred at distal occlusion sites and were often characterized by difficulty traversing the occlusion with a microcatheter or microwire, or while withdrawing the stent retriever. Nevertheless, 25% of patients had a favorable functional outcome, suggesting that in some patients with this complication good neurological recovery is achievable.