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; Basel Musmar; Hamza Salim; Sherief Ghozy; James E. Siegler; Hassan Kobeissi; Hamza Shaikh; Jane Khalife; Mohamad Abdalkader; Piers Klein; Thanh N. Nguyen; Jeremy J. Heit; Robert W. Regenhardt; Nicole M. Cancelliere; Joshua D. Bernstock; Kareem El Naamani; Abdelaziz Amllay; Lukas Meyer; Anne Dusart; Flavio Bellante; Géraud Forestier; Aymeric Rouchaud; Suzana Saleme; Charbel Mounayer; Jens Fiehler; Anna Luisa Kühn; Ajit S. Puri; Christian Dyzmann; Peter T. Kan; Marco Colasurdo; Gaultier Marnat; Jérôme Berge; Xavier Barreau; Igor Sibon; Simona Nedelcu; Nils Henninger; Thomas R. Marotta; Christopher J. Stapleton; James D. Rabinov; Takahiro Ota; Shogo Dofuku; Leonard L.L. Yeo; Benjamin Y.Q. Tan; Anil Gopinathan; Juan Carlos Martinez-Gutierrez; Sergio Salazar-Marioni; Sunil Sheth; Leonardo Renieri; Carolina Capirossi; Ashkan Mowla; Lina Chervak; Achala Vagal; Nimer Adeeb; Hugo H. Cuellar-Saenz; Stavropoula I. Tjoumakaris; Pascal Jabbour; Priyank Khandelwal; Arundhati Biswas; Frédéric Clarençon; Mahmoud Elhorany; Kevin Premat; Iacopo Valente; Alessandro Pedicelli; João Pedro Filipe; Ricardo Varela; Miguel Quintero-Consuegra; Nestor R. Gonzalez; Markus A. Möhlenbruch; Jessica Jesser; Vincent Costalat; Adrien ter Schiphorst; Vivek Yedavalli; Pablo Harker; Yasmin Aziz; Benjamin Gory; Christian Paul Stracke; Constantin Hecker; Ramanathan Kadirvel; Monika Killer-Oberpfalzer; Christoph J. Griessenauer; Ajith J. Thomas; Cheng Yang Hsieh; David S. Liebeskind; Răzvan Alexandru Radu; Andrea M. Alexandre; Illario Tancredi; Tobias D. Faizy; Robert Fahed; Charlotte Weyland; Boris Lubicz; Aman B. Patel; Vitor Mendes Pereira; Adrien Guenego

doi:10.1177/23969873231219412

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, Basel Musmar, Hamza Salim, Sherief Ghozy, James E. Siegler, Hassan Kobeissi, Hamza Shaikh, Jane Khalife, Mohamad Abdalkader, Piers Klein, Thanh N. Nguyen, Jeremy J. Heit, Robert W. Regenhardt, Nicole M. Cancelliere, Joshua D. Bernstock, Kareem El Naamani, Abdelaziz Amllay, Lukas Meyer, Anne Dusart, Flavio BellanteGéraud Forestier, Aymeric Rouchaud, Suzana Saleme, Charbel Mounayer, Jens Fiehler, Anna Luisa Kühn, Ajit S. Puri, Christian Dyzmann, Peter T. Kan, Marco Colasurdo, Gaultier Marnat, Jérôme Berge, Xavier Barreau, Igor Sibon, Simona Nedelcu, Nils Henninger, Thomas R. Marotta, Christopher J. Stapleton, James D. Rabinov, Takahiro Ota, Shogo Dofuku, Leonard L.L. Yeo, Benjamin Y.Q. Tan, Anil Gopinathan, Juan Carlos Martinez-Gutierrez, Sergio Salazar-Marioni, Sunil Sheth, Leonardo Renieri, Carolina Capirossi, Ashkan Mowla, Lina Chervak, Achala Vagal, Nimer Adeeb, Hugo H. Cuellar-Saenz, Stavropoula I. Tjoumakaris, Pascal Jabbour, Priyank Khandelwal, Arundhati Biswas, Frédéric Clarençon, Mahmoud Elhorany, Kevin Premat, Iacopo Valente, Alessandro Pedicelli, João Pedro Filipe, Ricardo Varela, Miguel Quintero-Consuegra, Nestor R. Gonzalez, Markus A. Möhlenbruch, Jessica Jesser, Vincent Costalat, Adrien ter Schiphorst, Vivek Yedavalli, Pablo Harker, Yasmin Aziz, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Ramanathan Kadirvel, Monika Killer-Oberpfalzer, Christoph J. Griessenauer, Ajith J. Thomas, Cheng Yang Hsieh, David S. Liebeskind, Răzvan Alexandru Radu, Andrea M. Alexandre, Illario Tancredi, Tobias D. Faizy, Robert Fahed, Charlotte Weyland, Boris Lubicz, Aman B. Patel, Vitor Mendes Pereira, Adrien Guenego

Radiology

Research output: Contribution to journal › Article › peer-review

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 (p = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, p < 0.001; TICI 2b-3: 56.5% vs 88.3%, p < 0.001). Functional outcomes were also worse in the perforation group (mRS 0–1 at 3 months: 22.7% vs 36.6%, p = 0.031; mRS 0–2 at 3 months: 28.8% vs 53.9%, p < 0.001). Mortality was higher in the perforation group (30.3% vs 16.8%, p = 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.

Original language	English (US)
Journal	European Stroke Journal
DOIs	https://doi.org/10.1177/23969873231219412
State	Accepted/In press - 2024

Keywords

AIS
MT
MeVo
Stroke
mechanical thrombectomy
perforation

ASJC Scopus subject areas

Clinical Neurology
Cardiology and Cardiovascular Medicine

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10.1177/23969873231219412

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Dmytriw, A. A., Musmar, B., Salim, H., Ghozy, S., Siegler, J. E., Kobeissi, H., Shaikh, H., Khalife, J., Abdalkader, M., Klein, P., Nguyen, T. N., Heit, J. J., Regenhardt, R. W., Cancelliere, N. M., Bernstock, J. D., Naamani, K. E., Amllay, A., Meyer, L., Dusart, A., ... Guenego, A. (Accepted/In press). Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study. European Stroke Journal. https://doi.org/10.1177/23969873231219412

Dmytriw, AA, Musmar, B, Salim, H, Ghozy, S, Siegler, JE, Kobeissi, H, Shaikh, H, Khalife, J, Abdalkader, M, Klein, P, Nguyen, TN, Heit, JJ, Regenhardt, RW, Cancelliere, NM, Bernstock, JD, Naamani, KE, Amllay, A, Meyer, L, Dusart, A, Bellante, F, Forestier, G, Rouchaud, A, Saleme, S, Mounayer, C, Fiehler, J, Kühn, AL, Puri, AS, Dyzmann, C, Kan, PT, Colasurdo, M, Marnat, G, Berge, J, Barreau, X, Sibon, I, Nedelcu, S, Henninger, N, Marotta, TR, Stapleton, CJ, Rabinov, JD, Ota, T, Dofuku, S, Yeo, LLL, Tan, BYQ, Gopinathan, A, Martinez-Gutierrez, JC, Salazar-Marioni, S, Sheth, S, Renieri, L, Capirossi, C, Mowla, A, Chervak, L, Vagal, A, Adeeb, N, Cuellar-Saenz, HH, Tjoumakaris, SI, Jabbour, P, Khandelwal, P, Biswas, A, Clarençon, F, Elhorany, M, Premat, K, Valente, I, Pedicelli, A, Filipe, JP, Varela, R, Quintero-Consuegra, M, Gonzalez, NR, Möhlenbruch, MA, Jesser, J, Costalat, V, ter Schiphorst, A, Yedavalli, V, Harker, P, Aziz, Y, Gory, B, Stracke, CP, Hecker, C, Kadirvel, R, Killer-Oberpfalzer, M, Griessenauer, CJ, Thomas, AJ, Hsieh, CY, Liebeskind, DS, Alexandru Radu, R, Alexandre, AM, Tancredi, I, Faizy, TD, Fahed, R, Weyland, C, Lubicz, B, Patel, AB, Pereira, VM & Guenego, A 2024, 'Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study', European Stroke Journal. https://doi.org/10.1177/23969873231219412

@article{8edcc081ea9d46168cb8eff5f05c5117,

title = "Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study",

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 (p = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, p < 0.001; TICI 2b-3: 56.5% vs 88.3%, p < 0.001). Functional outcomes were also worse in the perforation group (mRS 0–1 at 3 months: 22.7% vs 36.6%, p = 0.031; mRS 0–2 at 3 months: 28.8% vs 53.9%, p < 0.001). Mortality was higher in the perforation group (30.3% vs 16.8%, p = 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.",

keywords = "AIS, MT, MeVo, Stroke, mechanical thrombectomy, perforation",

author = "Dmytriw, {Adam A.} and Basel Musmar and Hamza Salim and Sherief Ghozy and Siegler, {James E.} and Hassan Kobeissi and Hamza Shaikh and Jane Khalife and Mohamad Abdalkader and Piers Klein and Nguyen, {Thanh N.} and Heit, {Jeremy J.} and Regenhardt, {Robert W.} and Cancelliere, {Nicole M.} and Bernstock, {Joshua D.} and Naamani, {Kareem El} and Abdelaziz Amllay and Lukas Meyer and Anne Dusart and Flavio Bellante and G{\'e}raud Forestier and Aymeric Rouchaud and Suzana Saleme and Charbel Mounayer and Jens Fiehler and K{\"u}hn, {Anna Luisa} and Puri, {Ajit S.} and Christian Dyzmann and Kan, {Peter T.} and Marco Colasurdo and Gaultier Marnat and J{\'e}r{\^o}me Berge and Xavier Barreau and Igor Sibon and Simona Nedelcu and Nils Henninger and Marotta, {Thomas R.} and Stapleton, {Christopher J.} and Rabinov, {James D.} and Takahiro Ota and Shogo Dofuku and Yeo, {Leonard L.L.} and Tan, {Benjamin Y.Q.} and Anil Gopinathan and Martinez-Gutierrez, {Juan Carlos} and Sergio Salazar-Marioni and Sunil Sheth and Leonardo Renieri and Carolina Capirossi and Ashkan Mowla and Lina Chervak and Achala Vagal and Nimer Adeeb and Cuellar-Saenz, {Hugo H.} and Tjoumakaris, {Stavropoula I.} and Pascal Jabbour and Priyank Khandelwal and Arundhati Biswas and Fr{\'e}d{\'e}ric Claren{\c c}on and Mahmoud Elhorany and Kevin Premat and Iacopo Valente and Alessandro Pedicelli and Filipe, {Jo{\~a}o Pedro} and Ricardo Varela and Miguel Quintero-Consuegra and Gonzalez, {Nestor R.} and M{\"o}hlenbruch, {Markus A.} and Jessica Jesser and Vincent Costalat and {ter Schiphorst}, Adrien and Vivek Yedavalli and Pablo Harker and Yasmin Aziz and Benjamin Gory and Stracke, {Christian Paul} and Constantin Hecker and Ramanathan Kadirvel and Monika Killer-Oberpfalzer and Griessenauer, {Christoph J.} and Thomas, {Ajith J.} and Hsieh, {Cheng Yang} and Liebeskind, {David S.} and {Alexandru Radu}, R{\u a}zvan and Alexandre, {Andrea M.} and Illario Tancredi and Faizy, {Tobias D.} and Robert Fahed and Charlotte Weyland and Boris Lubicz and Patel, {Aman B.} and Pereira, {Vitor Mendes} and Adrien Guenego",

note = "Publisher Copyright: {\textcopyright} European Stroke Organisation 2024.",

year = "2024",

doi = "10.1177/23969873231219412",

language = "English (US)",

journal = "European Stroke Journal",

issn = "2396-9873",

publisher = "Sage Publications",

}

TY - JOUR

T1 - Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke

T2 - A retrospective, multicenter, and multinational study

AU - Dmytriw, Adam A.

AU - Musmar, Basel

AU - Salim, Hamza

AU - Ghozy, Sherief

AU - Siegler, James E.

AU - Kobeissi, Hassan

AU - Shaikh, Hamza

AU - Khalife, Jane

AU - Abdalkader, Mohamad

AU - Klein, Piers

AU - Nguyen, Thanh N.

AU - Heit, Jeremy J.

AU - Regenhardt, Robert W.

AU - Cancelliere, Nicole M.

AU - Bernstock, Joshua D.

AU - Naamani, Kareem El

AU - Amllay, Abdelaziz

AU - Meyer, Lukas

AU - Dusart, Anne

AU - Bellante, Flavio

AU - Forestier, Géraud

AU - Rouchaud, Aymeric

AU - Saleme, Suzana

AU - Mounayer, Charbel

AU - Fiehler, Jens

AU - Kühn, Anna Luisa

AU - Puri, Ajit S.

AU - Dyzmann, Christian

AU - Kan, Peter T.

AU - Colasurdo, Marco

AU - Marnat, Gaultier

AU - Berge, Jérôme

AU - Barreau, Xavier

AU - Sibon, Igor

AU - Nedelcu, Simona

AU - Henninger, Nils

AU - Marotta, Thomas R.

AU - Stapleton, Christopher J.

AU - Rabinov, James D.

AU - Ota, Takahiro

AU - Dofuku, Shogo

AU - Yeo, Leonard L.L.

AU - Tan, Benjamin Y.Q.

AU - Gopinathan, Anil

AU - Martinez-Gutierrez, Juan Carlos

AU - Salazar-Marioni, Sergio

AU - Sheth, Sunil

AU - Renieri, Leonardo

AU - Capirossi, Carolina

AU - Mowla, Ashkan

AU - Chervak, Lina

AU - Vagal, Achala

AU - Adeeb, Nimer

AU - Cuellar-Saenz, Hugo H.

AU - Tjoumakaris, Stavropoula I.

AU - Jabbour, Pascal

AU - Khandelwal, Priyank

AU - Biswas, Arundhati

AU - Clarençon, Frédéric

AU - Elhorany, Mahmoud

AU - Premat, Kevin

AU - Valente, Iacopo

AU - Pedicelli, Alessandro

AU - Filipe, João Pedro

AU - Varela, Ricardo

AU - Quintero-Consuegra, Miguel

AU - Gonzalez, Nestor R.

AU - Möhlenbruch, Markus A.

AU - Jesser, Jessica

AU - Costalat, Vincent

AU - ter Schiphorst, Adrien

AU - Yedavalli, Vivek

AU - Harker, Pablo

AU - Aziz, Yasmin

AU - Gory, Benjamin

AU - Stracke, Christian Paul

AU - Hecker, Constantin

AU - Kadirvel, Ramanathan

AU - Killer-Oberpfalzer, Monika

AU - Griessenauer, Christoph J.

AU - Thomas, Ajith J.

AU - Hsieh, Cheng Yang

AU - Liebeskind, David S.

AU - Alexandru Radu, Răzvan

AU - Alexandre, Andrea M.

AU - Tancredi, Illario

AU - Faizy, Tobias D.

AU - Fahed, Robert

AU - Weyland, Charlotte

AU - Lubicz, Boris

AU - Patel, Aman B.

AU - Pereira, Vitor Mendes

AU - Guenego, Adrien

PY - 2024

Y1 - 2024

N2 - 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 (p = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, p < 0.001; TICI 2b-3: 56.5% vs 88.3%, p < 0.001). Functional outcomes were also worse in the perforation group (mRS 0–1 at 3 months: 22.7% vs 36.6%, p = 0.031; mRS 0–2 at 3 months: 28.8% vs 53.9%, p < 0.001). Mortality was higher in the perforation group (30.3% vs 16.8%, p = 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.

AB - 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 (p = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, p < 0.001; TICI 2b-3: 56.5% vs 88.3%, p < 0.001). Functional outcomes were also worse in the perforation group (mRS 0–1 at 3 months: 22.7% vs 36.6%, p = 0.031; mRS 0–2 at 3 months: 28.8% vs 53.9%, p < 0.001). Mortality was higher in the perforation group (30.3% vs 16.8%, p = 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.

KW - AIS

KW - MT

KW - MeVo

KW - Stroke

KW - mechanical thrombectomy

KW - perforation

UR - http://www.scopus.com/inward/record.url?scp=85186920418&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85186920418&partnerID=8YFLogxK

U2 - 10.1177/23969873231219412

DO - 10.1177/23969873231219412

M3 - Article

C2 - 38409796

AN - SCOPUS:85186920418

SN - 2396-9873

JO - European Stroke Journal

JF - European Stroke Journal

ER -

Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study

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Keywords

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