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Updated: Jul 20, 2025
Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
Published on: July 21, 2013
Incidence and outcome of perforations during medium vessel occlusion compared with large vessel occlusion
Victor Schulze-Zachau1, Alex Brehm2, Nikolaos Ntoulias2
1Diagnostic and Interventional Neuroradiology Department, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland victor.schulze-zachau@posteo.ch.
Background:
Vessel perforation during thrombectomy is a severe complication and is hypothesized to be more frequent during medium vessel occlusion (MeVO) thrombectomy. The aim of this study was to compare the incidence and outcome of patients with perforation during MeVO and large vessel occlusion (LVO) thrombectomy and to report on the procedural steps that led to perforation.
Methods:
In this multicenter retrospective cohort study, data of consecutive patients with vessel perforation during thrombectomy between January 1, 2015 and September 30, 2022 were collected. The primary outcomes were independent functional outcome (ie, modified Rankin Scale 0-2) and all-cause mortality at 90 days. Binomial test, chi-squared test and t-test for unpaired samples were used for statistical analysis.
Results:
During 25 769 thrombectomies (5124 MeVO, 20 645 LVO) in 25 stroke centers, perforation occurred in 335 patients (1.3%; mean age 72 years, 62% female). Perforation occurred more often in MeVO thrombectomy (2.4%) than in LVO thrombectomy (1.0%, p<0.001). More MeVO than LVO patients with perforation achieved functional independence at 3 months (25.7% vs 10.9%, p=0.001). All-cause mortality did not differ between groups (overall 51.6%). Navigation beyond the occlusion and retraction of stent retriever/aspiration catheter were the two most common procedural steps that led to perforation.
Conclusions:
In our cohort, perforation was approximately twice as frequent in MeVO than in LVO thrombectomy. Efforts to optimize the procedure may focus on navigation beyond the occlusion site and retraction of stent retriever/aspiration catheter. Further research is necessary in order to identify thrombectomy candidates at high risk of intraprocedural perforation and to provide data on the effectiveness of endovascular countermeasures.
Insights
Vessel perforation during mechanical thrombectomy is more common in medium vessel occlusion (MeVO) than large vessel occlusion (LVO) cases. Optimizing procedural techniques, especially navigation and catheter retraction, may reduce this complication.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Vessel perforation during mechanical thrombectomy is a significant complication.
- It is hypothesized to be more frequent in medium vessel occlusion (MeVO) compared to large vessel occlusion (LVO).
Purpose of the Study:
- To compare the incidence and outcomes of vessel perforation in MeVO versus LVO thrombectomy.
- To identify procedural steps associated with perforation during thrombectomy.
Main Methods:
- Multicenter retrospective cohort study of 25,769 thrombectomies (2015-2022).
- Data collected on patients experiencing vessel perforation.
- Primary outcomes: functional independence (modified Rankin Scale 0-2) and all-cause mortality at 90 days.
Main Results:
- Perforation occurred in 1.3% of cases, with a higher incidence in MeVO (2.4%) than LVO (1.0%) thrombectomy (p<0.001).
- MeVO patients with perforation had better functional independence at 3 months (25.7% vs 10.9%).
- Navigation beyond occlusion and catheter retraction were common causes of perforation. All-cause mortality did not differ.
Conclusions:
- Vessel perforation is approximately twice as frequent in MeVO thrombectomy compared to LVO.
- Procedural optimization focusing on navigation and catheter retraction is crucial.
- Further research is needed to identify high-risk patients and effective countermeasures.
