Sage Journals: Discover world-class research

Abstract

Background

There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes.

Aims

We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications.

Methods

From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected.

Results

The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21–2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13–8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66–12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31–0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97–0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19–0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6–0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02–1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02–1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25–2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26–3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08–2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55–0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up.

Conclusions

Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits.

Keywords

Complications mechanical thrombectomy acute ischemic stroke risk factors stroke incidence Italy endovascular stroke therapy thrombolysis cerebral infarction

Get full access to this article

View all access options for this article.

References

Mangiafico

Pracucci

Saia

, et al. The Italian Registry of Endovascular Treatment in Acute Stroke: rationale, design and baseline features of patients. Neurol Sci 2015; 36: 985–993.

von Elm

Altman

Egger

, et al. STROBE Initiative The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453–1457.

Balami

White

McMeekin

Ford

Buchan

. Complications of endovascular treatment for acute ischemic stroke: prevention and management. Int J Stroke 2018; 13: 348–361.

McCusker

Robinson

Looby

, et al. Endovascular treatment for acute ischaemic stroke with large vessel occlusion: the experience of a regional stroke service. Clin Radiol 2015; 70: 1408–1413.

Yoon

Jung

Park

Kim

Kang

. Subarachnoid hemorrhage in a multimodal approach heavily weighted toward mechanical thrombectomy with solitaire stent in acute stroke. Stroke 2013; 44: 414–419.

Mokin

Fargen

Primiani

, et al. Vessel perforation during stent retriever thrombectomy for acute ischemic stroke: technical details and clinical outcomes. J Neurointerv Surg 2017; 9: 922–928.

Davis

Deveikis

Harrigan

. Clinical presentation, imaging, and management of complications due to neurointerventional procedures. Semin Interv Radiol 2015; 32: 98–107.

Chueh

Puri

Wakhloo

Gounis

. Risk of distal embolization with stent retriever thrombectomy and ADAPT. J Neurointerv Surg 2016; 8: 197–202.

Acampa

Camarri

Lazzerini

, et al. Increased arterial stiffness is an independent risk factor for hemorrhagic transformation in ischemic stroke undergoing thrombolysis. Int J Cardiol 2017; 243: 466–470.

10.

Palombo

Kozakova

. Arterial stiffness, atherosclerosis and cardiovascular risk: pathophysiologic mechanisms and emerging clinical indications. Vascul Pharmacol 2016; 77: 1–7.

11.

Luthman AS, Bouchez L, Botta D, Vargas Gomez MI, Machi P and Lovblad KO. Imaging clot characteristics in stroke and its possible implication on treatment. Clin Neuroradiol. DOI: 10.1007/s00062-019-00841-w.

12.

Shi

Liebeskind

Loh

, et al. Predictors of subarachnoid hemorrhage in acute ischemic stroke with endovascular therapy. Stroke 2010; 41: 2775–2781.

13.

Kaesmacher

Boeckh-Behrens

Simon

, et al. Risk of thrombus fragmentation during endovascular stroke treatment. Am J Neuroradiol 2017; 38: 991–998.

14.

Hiraide

Sawano

Shiraishi

, et al. Impact of catheter-induced iatrogenic coronary artery dissection with or without post-procedural flow impairment: a report from a Japanese Multicenter Percutaneous Coronary Intervention Registry. PLoS One 2018; 13: e0204333.

15.

Papanagiotou

White

. Endovascular reperfusion strategies for acute stroke. JACC Cardiovasc Interv 2016; 9: 307–317.

16.

Hao

Yang

Wang

, et al. ACTUAL Investigators (Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry) Predictors for symptomatic intracranial hemorrhage after endovascular treatment of acute ischemic stroke. Stroke 2017; 48: 1203–1209.

17.

Broglio

Kontos

Levin

, et al. National Institute of Neurological Disorders and Stroke and Department of Defense Sport-Related Concussion Common Data Elements Version 1.0 recommendations. J Neurotrauma 2018; 35: 2776–2783.

18.

Lorenzano

Ahmed

Rosselli

, et al. Safe implementation of thrombolysis in stroke-monitoring study in Italy. Eur J Neurol 2010; 17: 163–167.

19.

Soize

Barbe

Kadziolka

Estrade

Serre

Pierot

. Predictive factors of outcome and haemorrhage after acute ischaemic stroke treated by mechanical thrombectomy with a stent retriever. Neuroradiology 2013; 55: 977–987.

20.

Mishra

Chistensen

Wounters

, et al., DEFUSE 2 investigators. Reperfusion of very low cerebral blood volume lesion predicts parenchymal hematoma after endovascular therapy. Stroke 2015; 46: 1245–1249.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.38 MB

Complications of mechanical thrombectomy for acute ischemic stroke: Incidence,risk factors,and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke