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Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of
Victor Schulze-Zachau1, Nikki Rommers2, Nikolaos Ntoulias1
1Department of Diagnostic & Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland.
Insights
Thrombectomy complication vessel perforation is severe, with high mortality. Thrombolysis did not worsen outcomes, but prompt bleeding cessation within 20 minutes is critical for survival.
Area of Science:
- Neurology
- Interventional Radiology
- Neurosurgery
Background:
- Complications of thrombectomy, specifically intracranial vessel perforation, are not well understood.
- This study investigates the characteristics of periprocedural intracranial vessel perforation and its impact on patient outcomes, including the role of thrombolysis.
Purpose of the Study:
- To characterize intracranial vessel perforation during thrombectomy.
- To evaluate the effect of thrombolysis on patient outcomes following vessel perforation.
- To identify factors associated with outcomes in patients experiencing vessel perforation.
Main Methods:
- Multicenter retrospective cohort study including patients with vessel perforation during thrombectomy (January 2015 - April 2023).
- Vessel perforation defined as active extravasation on digital subtraction angiography.
- Modified Rankin Scale (mRS) at 90 days was the primary outcome; proportional odds models assessed associated factors.
Main Results:
- 51.9% 90-day mortality in 459 patients with vessel perforation; only 16.3% achieved mRS 0-2.
- Large vessel perforation was independently associated with worse 90-day outcomes and poorer survival.
- Active bleeding >20 minutes was linked to worse survival; thrombolysis did not worsen outcomes or bleeding duration.
Conclusions:
- Intracranial vessel perforation during thrombectomy is a critical complication with high mortality.
- Thrombolysis does not appear to significantly worsen prognosis in patients with vessel perforation.
- Rapid cessation of active bleeding within 20 minutes is crucial for improving survival, highlighting the need for interventionalist training in complication management.
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.
