Vessel perforation during stent retriever thrombectomy for acute ischemic stroke

Technical details and clinical outcomes

Maxim Mokin, Kyle M. Fargen, Christopher T. Primiani, Zeguang Ren, Travis M Dumont, Leonardo B.C. Brasiliense, Guilherme Dabus, Italo Linfante, Peter Kan, Visish M. Srinivasan, Mandy J. Binning, Rishi Gupta, Aquilla S. Turk, Lucas Elijovich, Adam Arthur, Hussain Shallwani, Elad I. Levy, Adnan H. Siddiqui

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background Vessel perforation during stent retriever thrombectomy is a rare complication; typically only single instances have been reported. Objective To report on a series of patients whose stent retriever thrombectomy was complicated by intraprocedural vessel perforation and discuss its potential mechanisms, rescue treatment strategies, and clinical significance. Methods Cases with intraprocedural vessel perforation, where a stent retriever was used either as a primary treatment approach or as a part of a direct aspiration first pass technique (ADAPT), were included in the final analysis. Clinical data, procedural details, radiographic and clinical outcomes were collected from nine participating centers. Results Intraprocedural vessel perforation during stent retriever thrombectomy occurred in 16 (1.0%) of 1599 cases. 63% of intraprocedural perforations occurred at distal locations. Endovascular rescue techniques (most commonly, intracranial balloon occlusion for tamponade) were attempted in 50% of cases. Procedure was aborted without any rescue attempts in 44% of cases. Mortality during hospitalization and at 3 months was 56% and 63%, respectively. 25% of patients achieved good functional outcome at 3 months after the procedure. Conclusions Intraprocedural perforations during stent retriever thrombectomy were rare, but when they occurred were associated with high mortality. Perforations most commonly occurred at distal occlusion sites and were often characterized by difficulty traversing the occlusion with a microcatheter or microwire, or while withdrawing the stent retriever. Nevertheless, 25% of patients had a favorable functional outcome, suggesting that in some patients with this complication good neurological recovery is achievable.

Original languageEnglish (US)
Pages (from-to)922-928
Number of pages7
JournalJournal of NeuroInterventional Surgery
Volume9
Issue number10
DOIs
StatePublished - Oct 1 2017

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Thrombectomy
Stents
Stroke
Balloon Occlusion
Endovascular Procedures
Mortality
Hospitalization
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Vessel perforation during stent retriever thrombectomy for acute ischemic stroke : Technical details and clinical outcomes. / Mokin, Maxim; Fargen, Kyle M.; Primiani, Christopher T.; Ren, Zeguang; Dumont, Travis M; Brasiliense, Leonardo B.C.; Dabus, Guilherme; Linfante, Italo; Kan, Peter; Srinivasan, Visish M.; Binning, Mandy J.; Gupta, Rishi; Turk, Aquilla S.; Elijovich, Lucas; Arthur, Adam; Shallwani, Hussain; Levy, Elad I.; Siddiqui, Adnan H.

In: Journal of NeuroInterventional Surgery, Vol. 9, No. 10, 01.10.2017, p. 922-928.

Research output: Contribution to journalArticle

Mokin, M, Fargen, KM, Primiani, CT, Ren, Z, Dumont, TM, Brasiliense, LBC, Dabus, G, Linfante, I, Kan, P, Srinivasan, VM, Binning, MJ, Gupta, R, Turk, AS, Elijovich, L, Arthur, A, Shallwani, H, Levy, EI & Siddiqui, AH 2017, 'Vessel perforation during stent retriever thrombectomy for acute ischemic stroke: Technical details and clinical outcomes', Journal of NeuroInterventional Surgery, vol. 9, no. 10, pp. 922-928. https://doi.org/10.1136/neurintsurg-2016-012707
Mokin, Maxim ; Fargen, Kyle M. ; Primiani, Christopher T. ; Ren, Zeguang ; Dumont, Travis M ; Brasiliense, Leonardo B.C. ; Dabus, Guilherme ; Linfante, Italo ; Kan, Peter ; Srinivasan, Visish M. ; Binning, Mandy J. ; Gupta, Rishi ; Turk, Aquilla S. ; Elijovich, Lucas ; Arthur, Adam ; Shallwani, Hussain ; Levy, Elad I. ; Siddiqui, Adnan H. / Vessel perforation during stent retriever thrombectomy for acute ischemic stroke : Technical details and clinical outcomes. In: Journal of NeuroInterventional Surgery. 2017 ; Vol. 9, No. 10. pp. 922-928.
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title = "Vessel perforation during stent retriever thrombectomy for acute ischemic stroke: Technical details and clinical outcomes",
abstract = "Background Vessel perforation during stent retriever thrombectomy is a rare complication; typically only single instances have been reported. Objective To report on a series of patients whose stent retriever thrombectomy was complicated by intraprocedural vessel perforation and discuss its potential mechanisms, rescue treatment strategies, and clinical significance. Methods Cases with intraprocedural vessel perforation, where a stent retriever was used either as a primary treatment approach or as a part of a direct aspiration first pass technique (ADAPT), were included in the final analysis. Clinical data, procedural details, radiographic and clinical outcomes were collected from nine participating centers. Results Intraprocedural vessel perforation during stent retriever thrombectomy occurred in 16 (1.0{\%}) of 1599 cases. 63{\%} of intraprocedural perforations occurred at distal locations. Endovascular rescue techniques (most commonly, intracranial balloon occlusion for tamponade) were attempted in 50{\%} of cases. Procedure was aborted without any rescue attempts in 44{\%} of cases. Mortality during hospitalization and at 3 months was 56{\%} and 63{\%}, respectively. 25{\%} of patients achieved good functional outcome at 3 months after the procedure. Conclusions Intraprocedural perforations during stent retriever thrombectomy were rare, but when they occurred were associated with high mortality. Perforations most commonly occurred at distal occlusion sites and were often characterized by difficulty traversing the occlusion with a microcatheter or microwire, or while withdrawing the stent retriever. Nevertheless, 25{\%} of patients had a favorable functional outcome, suggesting that in some patients with this complication good neurological recovery is achievable.",
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T1 - Vessel perforation during stent retriever thrombectomy for acute ischemic stroke

T2 - Technical details and clinical outcomes

AU - Mokin, Maxim

AU - Fargen, Kyle M.

AU - Primiani, Christopher T.

AU - Ren, Zeguang

AU - Dumont, Travis M

AU - Brasiliense, Leonardo B.C.

AU - Dabus, Guilherme

AU - Linfante, Italo

AU - Kan, Peter

AU - Srinivasan, Visish M.

AU - Binning, Mandy J.

AU - Gupta, Rishi

AU - Turk, Aquilla S.

AU - Elijovich, Lucas

AU - Arthur, Adam

AU - Shallwani, Hussain

AU - Levy, Elad I.

AU - Siddiqui, Adnan H.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background Vessel perforation during stent retriever thrombectomy is a rare complication; typically only single instances have been reported. Objective To report on a series of patients whose stent retriever thrombectomy was complicated by intraprocedural vessel perforation and discuss its potential mechanisms, rescue treatment strategies, and clinical significance. Methods Cases with intraprocedural vessel perforation, where a stent retriever was used either as a primary treatment approach or as a part of a direct aspiration first pass technique (ADAPT), were included in the final analysis. Clinical data, procedural details, radiographic and clinical outcomes were collected from nine participating centers. Results Intraprocedural vessel perforation during stent retriever thrombectomy occurred in 16 (1.0%) of 1599 cases. 63% of intraprocedural perforations occurred at distal locations. Endovascular rescue techniques (most commonly, intracranial balloon occlusion for tamponade) were attempted in 50% of cases. Procedure was aborted without any rescue attempts in 44% of cases. Mortality during hospitalization and at 3 months was 56% and 63%, respectively. 25% of patients achieved good functional outcome at 3 months after the procedure. Conclusions Intraprocedural perforations during stent retriever thrombectomy were rare, but when they occurred were associated with high mortality. Perforations most commonly occurred at distal occlusion sites and were often characterized by difficulty traversing the occlusion with a microcatheter or microwire, or while withdrawing the stent retriever. Nevertheless, 25% of patients had a favorable functional outcome, suggesting that in some patients with this complication good neurological recovery is achievable.

AB - Background Vessel perforation during stent retriever thrombectomy is a rare complication; typically only single instances have been reported. Objective To report on a series of patients whose stent retriever thrombectomy was complicated by intraprocedural vessel perforation and discuss its potential mechanisms, rescue treatment strategies, and clinical significance. Methods Cases with intraprocedural vessel perforation, where a stent retriever was used either as a primary treatment approach or as a part of a direct aspiration first pass technique (ADAPT), were included in the final analysis. Clinical data, procedural details, radiographic and clinical outcomes were collected from nine participating centers. Results Intraprocedural vessel perforation during stent retriever thrombectomy occurred in 16 (1.0%) of 1599 cases. 63% of intraprocedural perforations occurred at distal locations. Endovascular rescue techniques (most commonly, intracranial balloon occlusion for tamponade) were attempted in 50% of cases. Procedure was aborted without any rescue attempts in 44% of cases. Mortality during hospitalization and at 3 months was 56% and 63%, respectively. 25% of patients achieved good functional outcome at 3 months after the procedure. Conclusions Intraprocedural perforations during stent retriever thrombectomy were rare, but when they occurred were associated with high mortality. Perforations most commonly occurred at distal occlusion sites and were often characterized by difficulty traversing the occlusion with a microcatheter or microwire, or while withdrawing the stent retriever. Nevertheless, 25% of patients had a favorable functional outcome, suggesting that in some patients with this complication good neurological recovery is achievable.

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U2 - 10.1136/neurintsurg-2016-012707

DO - 10.1136/neurintsurg-2016-012707

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SP - 922

EP - 928

JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

SN - 1759-8478

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