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

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2024-08-22 DOI:10.1177/23969873241272542

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

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引用次数: 0

Abstract

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.

查看原文本刊更多论文

"深入了解血栓切除术中的血管穿孔：严重并发症的特征和溶栓治疗的效果"。

导言：对血栓切除术并发症的研究仍然很少。本研究旨在描述围手术期颅内血管穿孔的特征，包括溶栓对患者预后的影响：在这项多中心回顾性队列研究中，纳入了 2015 年 1 月至 2023 年 4 月期间在血栓切除术中发生血管穿孔的连续患者。血管穿孔的定义是数字减影血管造影中出现活动性外渗。主要结果是90天后的改良Rankin量表（mRS）。采用比例赔率模型评估与主要结果相关的因素：共纳入 459 名血管穿孔患者（平均年龄为 72.5 ± 13.6 岁，59% 为女性，41% 接受了溶栓治疗）。90天后的死亡率为51.9%，16.3%的患者在90天后达到mRS 0-2。溶栓与90天后的预后不相关。大血管（LV）穿孔与中/远端血管穿孔相比，与90天后较差的预后独立相关（aOR 1.709，p = 0.04），LV穿孔与较差的生存概率相关（HR 1.389，p = 0.021）。活动性出血时间超过20分钟的患者生存概率也较低（HR 1.797，P = 0.009）。溶栓与出血持续时间延长无关。与临时措施相比，永久性血管闭塞能更快地止血（中位数差异为 4 分钟，P = 0.009）：讨论与结论：血栓切除术中的血管穿孔是一种严重且经常致命的并发症。本研究并未表明溶栓会明显导致预后恶化。在 20 分钟内及时停止活动性出血至关重要，这强调了介入医师接受并发症处理培训的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.