O36 Insights into vessel perforations during thrombectomy: characteristics of a severe complication and effect of thrombolysis

<h3>Introduction</h3> Complications associated with thrombectomy remain poorly explored<sup>1-5</sup>. <h3>Aim of Study</h3> To characterize periprocedural vessel perforation and to assess the effect of thrombolysis on patient outcomes. <h3>Methods</h3> 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 contrast 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. <h3>Results</h3> 459 patients with vessel perforation were included (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 (MDV) 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 &gt;20 minutes had worse survival probability (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 minutes, p&lt;0.001). <h3>Conclusion</h3> Vessel perforation during thrombectomy is a severe and frequently fatal complication. Thrombolysis does not significantly attribute to worse prognosis. Outcome and survival after LV perforation is worse compared to MDV perforation. Cessation of active bleeding within 20 minutes is critical, emphasizing the need for interventionalists to be trained in complication management. <h3>Disclosure of Interest</h3> yes V. S.-Z. discloses speaker fees from Medtronic Inc. (money paid to institution). M.R.L. discloses unrestricted educational grants from Medtronic and Stryker; consulting for Medtronic, Stereotaxis, Metis Innovative and Aeaean Advisers; equity interest in Proprio, Fluid Biomed, Stroke Diagnostics, Hyperion Surgical, Apertur; editorial board of Journal of NeuroInterventional Surgery; data safety monitoring board of Arsenal Medical. M.-N.P. discloses unrestricted grants from Swiss National Science Foundation (SNF), Bangerter-Rhyner Stiftung, Stryker Neurovascular Inc., Phenox GmbH, Medtronic Inc., Rapid Medical Inc., and Penumbra Inc for the DISTAL trial, grant for SPINNERS trial from Siemens Healthineers AG (money paid to institution) and the following speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Rapid Medical Inc. and Siemens Healthineers AG (money paid to institution).

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Abstracts
Published
2024-09-01
DOI
https://doi.org/10.1136/jnis-2024-esmint.36
Primary Topic
Venous Thromboembolism Diagnosis and Management
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article
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article

O36 Insights into vessel perforations during thrombectomy: characteristics of a severe complication and effect of thrombolysis

Alex Brehm, Franziska Dorn, Urs Fischer, Gautam Edhayan et al.
Abstracts
Venous Thromboembolism Diagnosis and Management
article

O36 Insights into vessel perforations during thrombectomy: characteristics of a severe complication and effect of thrombolysis

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

Abstract

<h3>Introduction</h3> Complications associated with thrombectomy remain poorly explored<sup>1-5</sup>. <h3>Aim of Study</h3> To characterize periprocedural vessel perforation and to assess the effect of thrombolysis on patient outcomes. <h3>Methods</h3> 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 contrast 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. <h3>Results</h3> 459 patients with vessel perforation were included (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 (MDV) 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 &gt;20 minutes had worse survival probability (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 minutes, p&lt;0.001). <h3>Conclusion</h3> Vessel perforation during thrombectomy is a severe and frequently fatal complication. Thrombolysis does not significantly attribute to worse prognosis. Outcome and survival after LV perforation is worse compared to MDV perforation. Cessation of active bleeding within 20 minutes is critical, emphasizing the need for interventionalists to be trained in complication management. <h3>Disclosure of Interest</h3> yes V. S.-Z. discloses speaker fees from Medtronic Inc. (money paid to institution). M.R.L. discloses unrestricted educational grants from Medtronic and Stryker; consulting for Medtronic, Stereotaxis, Metis Innovative and Aeaean Advisers; equity interest in Proprio, Fluid Biomed, Stroke Diagnostics, Hyperion Surgical, Apertur; editorial board of Journal of NeuroInterventional Surgery; data safety monitoring board of Arsenal Medical. M.-N.P. discloses unrestricted grants from Swiss National Science Foundation (SNF), Bangerter-Rhyner Stiftung, Stryker Neurovascular Inc., Phenox GmbH, Medtronic Inc., Rapid Medical Inc., and Penumbra Inc for the DISTAL trial, grant for SPINNERS trial from Siemens Healthineers AG (money paid to institution) and the following speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Rapid Medical Inc. and Siemens Healthineers AG (money paid to institution).

Abstracts
University of Bern (CH), University of Iowa (US), Brigham and Women's Hospital (US), St. Michael's Hospital (CA), Vrije Universiteit Brussel (BE), Medical University of South Carolina (US), Universität Hamburg (DE), University of Washington (US), Heidelberg University (DE), University Hospital Bonn (DE), Cooper University Hospital (US), Liverpool Hospital (AU), University Hospital of Bern (CH), Turku University Hospital (FI), University Hospital Augsburg (DE), University Hospital Heidelberg (DE), University Hospital of Basel (CH), TUM Klinikum (DE), Jackson Memorial Hospital (US), Hospital Clínico San Carlos (ES), Humboldt-Universität zu Berlin (DE), Massachusetts General Hospital (US), Laboratory for Biomedical Neurosciences (CH), Hospital Base (CL), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Unidade Local de Saúde de São José (PT), University Hospital of Geneva (CH), University Medical Center Hamburg-Eppendorf (DE), Prince of Wales Hospital (AU), Luzerner Kantonsspital (CH), Universitair Ziekenhuis Brussel (BE), Vall d'Hebron Hospital Universitari (ES), Department of Biomedicine Basel (CH), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), Grand Charleroi Hospital (BE), University Hospital Ulm (DE), Cooper University Health Care (US), University Hospital Carl Gustav Carus (DE), The Neurological Institute (US), Heinrich Heine University Düsseldorf (DE), The University of Texas Medical Branch at Galveston (US), Technical University of Munich (DE), Charité - Universitätsmedizin Berlin (DE), Universidade Nova de Lisboa (PT), Otto-von-Guericke-Universität Magdeburg (DE), University of Lausanne (CH)
National Science Foundation, Medtronic, Stryker, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Siemens Healthineers
Openalex Percentile: Top 71%
Venous Thromboembolism Diagnosis and Management
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