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Schulze-Zachau V, Rommers N, Ntoulias N, Brehm A, Krug N, Tsogkas I, Mutke M, Rusche T, Cervo A, Rollo C, Möhlenbruch M, Jesser J, Kreiser K, Althaus K, Requena M, Rodrigo-Gisbert M, Dobrocky T, Serrallach BL, Nolte CH, Riegler C, Nawabi J, Maslias E, Michel P, Saliou G, Manning N, McQuinn A, Taylor A, Maurer CJ, Berlis A, Kaiser DP, Cuberi A, Moreu M, López-Frías A, Pérez-García C, Rautio R, Pauli Y, Limbucci N, Renieri L, Fragata I, Rodriguez-Ares T, Kirschke JS, Schwarting J, Al Kasab S, Spiotta AM, Abu Qdais A, Dmytriw AA, Regenhardt RW, Patel AB, Pereira VM, Cancelliere NM, Schmeel C, Dorn F, Sauer M, Karwacki GM, Khalife J, Thomas AJ, Shaikh HA, Commodaro C, Pileggi M, Schwab R, Bellante F, Dusart A, Hofmeister J, Machi P, Samaniego EA, Ojeda DJ, Starke RM, Abdelsalam A, van den Bergh F, De Raedt S, Bester M, Flottmann F, Weiss D, Kaschner M, Kan PT, Edhayan G, Levitt MR, Raub SL, Katan M, Fischer U, Psychogios MN. "Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis". Eur Stroke J 2024:23969873241272542. [PMID: 39171391 DOI: 10.1177/23969873241272542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
INTRODUCTION Thrombectomy complications remain poorly explored. This study aims to characterize periprocedural intracranial vessel perforation including the effect of thrombolysis on patient outcomes. PATIENTS AND 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 active 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 (mean age 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 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 min had worse survival probability, too (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 min, p < 0.001). DISCUSSION AND CONCLUSION Vessel perforation during thrombectomy is a severe and frequently fatal complication. This study does not suggest that thrombolysis significantly attributes to worse prognosis. Prompt cessation of active bleeding within 20 min is critical, emphasizing the need for interventionalists to be trained in complication management.
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Affiliation(s)
- Victor Schulze-Zachau
- Department of Diagnostic & Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - Nikki Rommers
- Clinical Research Department, University Basel, Basel, Switzerland
| | - Nikolaos Ntoulias
- Department of Diagnostic & Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - Alex Brehm
- Department of Diagnostic & Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - Nadja Krug
- Department of Diagnostic & Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - Ioannis Tsogkas
- Department of Diagnostic & Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - Matthias Mutke
- Department of Diagnostic & Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - Thilo Rusche
- Department of Diagnostic & Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - Amedeo Cervo
- Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Claudia Rollo
- Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Markus Möhlenbruch
- Vascular & Interventional Neuroradiology Section, Minimal Invasive NeuroTherapy Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Jessica Jesser
- Vascular & Interventional Neuroradiology Section, Minimal Invasive NeuroTherapy Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Kornelia Kreiser
- Radiology and Neuroradiology Clinic, University and Rehabilitation Clinic Ulm, Ulm, Germany
| | | | - Manuel Requena
- Interventional Neuroradiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Tomas Dobrocky
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Bettina L Serrallach
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christian H Nolte
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
- Center for Stroke Research Berlin (CSBand Berlin Institute of Healths (BIH), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Riegler
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
- Center for Stroke Research Berlin (CSBand Berlin Institute of Healths (BIH), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jawed Nawabi
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany
| | - Errikos Maslias
- Stroke Center, Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Patrik Michel
- Stroke Center, Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Guillaume Saliou
- Interventional Neuroradiological Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Nathan Manning
- Department of Interventional Radiology, Liverpool Hospital, Sydney, Australia
- Neurointervention and Neurovascular Clinic, Prince of Wales Hospital, Sydney, Australia
| | - Alexander McQuinn
- Department of Interventional Radiology, Liverpool Hospital, Sydney, Australia
- Neurointervention and Neurovascular Clinic, Prince of Wales Hospital, Sydney, Australia
| | - Alon Taylor
- Neurointervention and Neurovascular Clinic, Prince of Wales Hospital, Sydney, Australia
| | - Christoph J Maurer
- Department of Diagnostic and Interventional Neuroradiology, Augsburg University Hospital, Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, Augsburg University Hospital, Germany
| | - Daniel Po Kaiser
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Ani Cuberi
- Department of Radiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Manuel Moreu
- Neurointerventional Unit, Radiology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Alfonso López-Frías
- Neurointerventional Unit, Radiology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Carlos Pérez-García
- Neurointerventional Unit, Radiology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Riitta Rautio
- Department of Interventional Radiology, Turku University Hospital, Finland
| | - Ylikotila Pauli
- Department of Interventional Radiology, Turku University Hospital, Finland
| | - Nicola Limbucci
- Department of Neurovascular Intervention, Ospedale Careggi di Firenze, Florence, Italy
| | - Leonardo Renieri
- Department of Neurovascular Intervention, Ospedale Careggi di Firenze, Florence, Italy
| | - Isabel Fragata
- NOVA Medical School, Lisbon, Portugal
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Tania Rodriguez-Ares
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Julian Schwarting
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ahmad Abu Qdais
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vitor Mendes Pereira
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Nicole M Cancelliere
- Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Carsten Schmeel
- Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Franziska Dorn
- Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Malte Sauer
- Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Grzegorz M Karwacki
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Jane Khalife
- Department of Neurology, Cooper Neurological Institute, Camden, NJ, USA
| | - Ajith J Thomas
- Department of Neurosurgery, Cooper Neurological Institute, Camden, NJ, USA
| | - Hamza A Shaikh
- Department of Neurointerventional Surgery, Cooper Neurological Institute, Camden, NJ, USA
| | - Christian Commodaro
- Department of Diagnostic and Interventional Neuroradiology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
| | - Marco Pileggi
- Department of Diagnostic and Interventional Neuroradiology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
| | - Roland Schwab
- University Clinic for Neuroradiology, Medical Faculty, Otto-Von-Guericke-University, Magdeburg, Germany
| | | | - Anne Dusart
- Service de Neurologie, CHU de Charleroi, Charleroi, Belgium
| | - Jeremy Hofmeister
- Service of Diagnostic and Interventional Neuroradiology, Geneva University Hospital, Geneva, Switzerland
| | - Paolo Machi
- Service of Diagnostic and Interventional Neuroradiology, Geneva University Hospital, Geneva, Switzerland
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa, College of Medicine, Iowa City, IA, USA
- Department of Neurosurgery, University of Iowa, College of Medicine, Iowa City, IA, USA
- University of Iowa, College of Medicine, Iowa City, IA, USA
| | - Diego J Ojeda
- University of Iowa, College of Medicine, Iowa City, IA, USA
| | - Robert M Starke
- Miami Miller School of Medicine, Jackson Memorial Hospital, University of Miami Hospital, Miami, USA
| | - Ahmed Abdelsalam
- Miami Miller School of Medicine, Jackson Memorial Hospital, University of Miami Hospital, Miami, USA
| | - Frans van den Bergh
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sylvie De Raedt
- Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Maxim Bester
- Department of Neuroradiology, University Hospital Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Neuroradiology, University Hospital Eppendorf, Hamburg, Germany
| | - Daniel Weiss
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Marius Kaschner
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Peter T Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Gautam Edhayan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Michael R Levitt
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Spencer L Raub
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Mira Katan
- Clinical Research Department, University Basel, Basel, Switzerland
- Neurology Clinic, University Hospital Basel, Basel, Switzerland
| | - Urs Fischer
- Clinical Research Department, University Basel, Basel, Switzerland
- Neurology Clinic, University Hospital Basel, Basel, Switzerland
| | - Marios-Nikos Psychogios
- Department of Diagnostic & Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
- Clinical Research Department, University Basel, Basel, Switzerland
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Riegler C, von Rennenberg R, Bollweg K, Nguyen TN, Kleine JF, Tiedt S, Audebert HJ, Siebert E, Nolte CH. Endovascular therapy in patients with internal carotid artery occlusion and patent circle of Willis. J Neurointerv Surg 2024; 16:644-651. [PMID: 37491381 PMCID: PMC11228208 DOI: 10.1136/jnis-2023-020556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/24/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Occlusion of the internal carotid artery (ICA) may extend into the middle or anterior cerebral artery (ICA-T) or be confined to the intracranial (ICA-I) or extracranial segment (ICA-E). While there is excellent evidence for endovascular therapy (EVT) in ICA-T occlusions, studies on EVT in non-tandem ICA-I or ICA-E occlusions are scarce. OBJECTIVE To characterize EVT-treated patients with ICA-I- and ICA-E occlusion by comparing them with ICA-T occlusions. METHODS The German Stroke Registry (GSR), a national, multicenter, prospective registry was searched for EVT-treated patients with isolated ICA occlusion between June 2015 and December 2021. We stratified patients by ICA occlusion site: (a) ICA-T, (b) ICA-I, (c) ICA-E. Baseline factors, procedural variables, technical (modified Thrombolysis in Cerebral Infarction (mTICI)), and functional outcomes (modified Rankin scale score at 3 months) were analyzed. RESULTS Of 13 082 GSR patients, 2588 (19.8%) presented with an isolated ICA occlusion, thereof 1946 (75.2%) ICA-T, 366 (14.1%) ICA-I, and 276 (10.7%) ICA-E patients. The groups differed in age (77 vs 76 vs 74 years, Ptrend=0.02), sex (53.4 vs 48.9 vs 43.1% female, Ptrend<0.01), and stroke severity (median National Institutes of Health Stroke Scale score at admission 17 vs 14 vs 13 points, Ptrend<0.001). In comparison with ICA-T occlusions, both ICA-I and ICA-E occlusions had lower rates of successful recanalization (mTICI 2b/3: 85.4% vs 80.4% vs 76.3%; aOR (95% CI for ICA-I vs ICA-T 0.71 (0.53 to 0.95); aOR (95% CI) for ICA-E vs ICA-T 0.57 (0.42 to 0.78)). In adjusted analyses, ICA-E occlusion was associated with worse outcome when compared with ICA-T occlusion (mRS ordinal shift, cOR (95% CI) 0.70 (0.52 to 0.93)). CONCLUSION Patient characteristics and outcomes differ substantially between ICA-T, ICA-I, and ICA-E occlusions. These results warrant further studies on EVT in ICA-I and ICA-E patients.
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Affiliation(s)
- Christoph Riegler
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin (CSB), Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Regina von Rennenberg
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin (CSB), Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Kerstin Bollweg
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin (CSB), Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
- Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Justus F Kleine
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Steffen Tiedt
- Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Heinrich J Audebert
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin (CSB), Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Christian H Nolte
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin (CSB), Charité Universitatsmedizin Berlin, Berlin, Germany
- Berlin Insititute of Health at Charité, Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Berlin, Germany
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