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  3. "Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis".
 

"Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis".

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BORIS DOI
10.48350/199926
Date of Publication
March 2025
Publication Type
Article
Division/Institute

Universitätsinstitut ...

Author
Schulze-Zachau, Victor
Rommers, Nikki
Ntoulias, Nikolaos
Brehm, Alex
Krug, Nadja
Tsogkas, Ioannis
Mutke, Matthias
Rusche, Thilo
Cervo, Amedeo
Rollo, Claudia
Möhlenbruch, Markus
Jesser, Jessica
Kreiser, Kornelia
Althaus, Katharina
Requena, Manuel
Rodrigo-Gisbert, Marc
Dobrocky, Tomas
Universitätsinstitut für Diagnostische und Interventionelle Neuroradiologie (DIN)
Serrallach, Bettina Lara
Universitätsinstitut für Diagnostische und Interventionelle Neuroradiologie (DIN)
Nolte, Christian H
Riegler, Christoph
Nawabi, Jawed
Maslias, Errikos
Michel, Patrik
Saliou, Guillaume
Manning, Nathan
McQuinn, Alexander
Taylor, Alon
Maurer, Christoph J
Berlis, Ansgar
Kaiser, Daniel Po
Cuberi, Ani
Moreu, Manuel
López-Frías, Alfonso
Pérez-García, Carlos
Rautio, Riitta
Pauli, Ylikotila
Limbucci, Nicola
Renieri, Leonardo
Fragata, Isabel
Rodriguez-Ares, Tania
Kirschke, Jan S
Schwarting, Julian
Al Kasab, Sami
Spiotta, Alejandro M
Abu Qdais, Ahmad
Dmytriw, Adam A
Regenhardt, Robert W
Patel, Aman B
Pereira, Vitor Mendes
Cancelliere, Nicole M
Schmeel, Carsten
Dorn, Franziska
Sauer, Malte
Karwacki, Grzegorz M
Khalife, Jane
Thomas, Ajith J
Shaikh, Hamza A
Commodaro, Christian
Pileggi, Marco
Schwab, Roland
Bellante, Flavio
Dusart, Anne
Hofmeister, Jeremy
Machi, Paolo
Samaniego, Edgar A
Ojeda, Diego J
Starke, Robert M
Abdelsalam, Ahmed
van den Bergh, Frans
De Raedt, Sylvie
Bester, Maxim
Flottmann, Fabian
Weiss, Daniel
Kaschner, Marius
Kan, Peter T
Edhayan, Gautam
Levitt, Michael R
Raub, Spencer L
Katan, Mira
Fischer, Urs
Psychogios, Marios-Nikos
Subject(s)

600 - Technology::610...

Series
European stroke journal
ISSN or ISBN (if monograph)
2396-9873
Publisher
Sage
Language
English
Publisher DOI
10.1177/23969873241272542
PubMed ID
39171391
Uncontrolled Keywords

Stroke complication i...

Description
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.
Handle
https://boris-portal.unibe.ch/handle/20.500.12422/179939
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