NYMC Faculty Publications

Incidence and Clinical Outcomes of Perforations During Mechanical Thrombectomy for Medium Vessel Occlusion in Acute Ischemic Stroke: A Retrospective, Multicenter, and Multinational Study

Adam A. Dmytriw, Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Basel Musmar, Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA.
Hamza Salim, Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Sherief Ghozy, Department of Neurological Surgery and Radiology, Mayo Clinic, Rochester, MN, USA.
James E. Siegler, Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
Hassan Kobeissi, Department of Neurological Surgery and Radiology, Mayo Clinic, Rochester, MN, USA.
Hamza Shaikh, Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
Jane Khalife, Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
Mohamad Abdalkader, Departments of Radiology and Neurology, Boston Medical Center, Boston, MA, USA.Follow
Piers Klein, Departments of Radiology and Neurology, Boston Medical Center, Boston, MA, USA.Follow
Thanh N. Nguyen, Departments of Radiology and Neurology, Boston Medical Center, Boston, MA, USA.
Jeremy J. Heit, Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.
Robert W. Regenhardt, Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Nicole M. Cancelliere, Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, ON, Canada.
Joshua D. Bernstock, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA.
Kareem El Naamani, Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
Abdelaziz Amllay, Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.Follow
Lukas Meyer, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Anne Dusart, Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
Flavio Bellante, Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
Géraud Forestier, University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
Aymeric Rouchaud, University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
Suzana Saleme, University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
Charbel Mounayer, University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
Jens Fiehler, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Anna Luisa Kühn, Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
Ajit S. Puri, Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
Christian Dyzmann, Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany.
Peter T. Kan, Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA.
Marco Colasurdo, Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA.
Gaultier Marnat, Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.Follow
Jérôme Berge, Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.

Author Type(s)

Faculty

DOI

10.1177/23969873231219412

Journal Title

European Stroke Journal

First Page

328

Last Page

337

Document Type

Article

Publication Date

6-1-2024

Department

Neurosurgery

Abstract

BACKGROUND: Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO. METHODS: Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. A total of 1373 AIS patients with MeVO underwent MT. Baseline characteristics, procedural details, and clinical outcomes were analyzed. RESULTS: The incidence of vessel perforation was 4.8% (66/1373). Notably, our analysis indicates variations in perforation rates across different arterial segments: 8.9% in M3 segments, 4.3% in M2 segments, and 8.3% in A2 segments ( = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%,  < 0.001; TICI 2b-3: 56.5% vs 88.3%,  < 0.001). Functional outcomes were also worse in the perforation group (mRS 0-1 at 3 months: 22.7% vs 36.6%,  = 0.031; mRS 0-2 at 3 months: 28.8% vs 53.9%,  < 0.001). Mortality was higher in the perforation group (30.3% vs 16.8%,  = 0.008). CONCLUSION: This study reveals that while the occurrence of vessel perforation in MT for AIS due to MeVO is relatively rare, it is associated with poor functional outcomes and higher mortality. The findings highlight the need for increased caution and specialized training in performing MT for MeVO. Further prospective research is required for risk mitigation strategies.

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