Clinical consequence of vessel perforations during endovascular treatment of acute ischemic stroke

P. Matthijs van der Sluijs; Ruisheng Su; S.A.P. Cornelissen; Adriaan C.G.M. van Es; Geert J. Lycklama à Nijeholt; B. Roozenbeek; P.J. van Doormaal; J. Hofmeijer; A. van der Lugt; T. van Walsum; MR CLEAN Registry investigators

doi:10.1007/s00234-023-03246-2

Clinical consequence of vessel perforations during endovascular treatment of acute ischemic stroke

P. Matthijs van der Sluijs (Corresponding author)
, Ruisheng Su
, S.A.P. Cornelissen
, Adriaan C.G.M. van Es
, Geert J. Lycklama à Nijeholt
, B. Roozenbeek
, P.J. van Doormaal
, J. Hofmeijer
, A. van der Lugt
, T. van Walsum
, MR CLEAN Registry investigators

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

5 Citations (Scopus)

Abstract

PURPOSE: Endovascular treatment (EVT) of acute ischemic stroke can be complicated by vessel perforation. We studied the incidence and determinants of vessel perforations. In addition, we studied the association of vessel perforations with functional outcome, and the association between location of perforation on digital subtraction angiography (DSA) and functional outcome, using a large EVT registry.

METHODS: We included all patients in the MR CLEAN Registry who underwent EVT. We used DSA to determine whether EVT was complicated by a vessel perforation. We analyzed the association with baseline clinical and interventional parameters using logistic regression models. Functional outcome was measured using the modified Rankin Scale at 90 days. The association between vessel perforation and angiographic imaging features and functional outcome was studied using ordinal logistic regression models adjusted for prognostic parameters. These associations were expressed as adjusted common odds ratios (acOR).

RESULTS: Vessel perforation occurred in 74 (2.6%) of 2794 patients who underwent EVT. Female sex (aOR 2.0 (95% CI 1.2-3.2)) and distal occlusion locations (aOR 2.2 (95% CI 1.3-3.5)) were associated with increased risk of vessel perforation. Functional outcome was worse in patients with vessel perforation (acOR 0.38 (95% CI 0.23-0.63)) compared to patients without a vessel perforation. No significant association was found between location of perforation and functional outcome.

CONCLUSION: The incidence of vessel perforation during EVT in this cohort was low, but has severe clinical consequences. Female patients and patients treated at distal occlusion locations are at higher risk.

Original language	English
Pages (from-to)	237-247
Number of pages	11
Journal	Neuroradiology
Volume	66
Issue number	2
DOIs	https://doi.org/10.1007/s00234-023-03246-2
Publication status	Published - Feb 2024
Externally published	Yes

Funding

The MR CLEAN Registry was partly funded by TWIN Foundation, Erasmus MC University Medical Center, Maastricht University Medical Center, and Amsterdam UMC. Erasmus MC received funds from Stryker® by DD, AvdL, and Bracco Imaging® by DD. Amsterdam UMC received funds from Stryker® for consultations by CM, YR, and OB. MUMC received funds from Stryker® and Codman® for consultations by WZ. The current work on clinical consequence of vessel perforations was supported by Health-Holland (TKI Life Sciences and Health) through the Q-Maestro project under Grant EMCLSH19006 and Philips Healthcare (Best, The Netherlands).

Funders	Funder number
Erasmus University Medical Center
Amsterdam University Medical Center	EMCLSH19006
Maastricht University Medical Center

Keywords

Humans
Female
Stroke
Ischemic Stroke/etiology
Brain Ischemia/etiology
Treatment Outcome
Endovascular Procedures/adverse effects
Thrombectomy/methods
Vessel perforation
Complications
Adverse effects
Ischemic stroke
Thrombectomy
Determinants

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10.1007/s00234-023-03246-2

Cite this

van der Sluijs, P. M., Su, R., Cornelissen, S. A. P., van Es, A. C. G. M., Lycklama à Nijeholt, G. J., Roozenbeek, B., van Doormaal, P. J., Hofmeijer, J., van der Lugt, A., van Walsum, T., & MR CLEAN Registry investigators (2024). Clinical consequence of vessel perforations during endovascular treatment of acute ischemic stroke. Neuroradiology, 66(2), 237-247. https://doi.org/10.1007/s00234-023-03246-2

@article{c5ddf9f01f274bf8a6a6ac71f24a78f1,

title = "Clinical consequence of vessel perforations during endovascular treatment of acute ischemic stroke",

abstract = "PURPOSE: Endovascular treatment (EVT) of acute ischemic stroke can be complicated by vessel perforation. We studied the incidence and determinants of vessel perforations. In addition, we studied the association of vessel perforations with functional outcome, and the association between location of perforation on digital subtraction angiography (DSA) and functional outcome, using a large EVT registry.METHODS: We included all patients in the MR CLEAN Registry who underwent EVT. We used DSA to determine whether EVT was complicated by a vessel perforation. We analyzed the association with baseline clinical and interventional parameters using logistic regression models. Functional outcome was measured using the modified Rankin Scale at 90 days. The association between vessel perforation and angiographic imaging features and functional outcome was studied using ordinal logistic regression models adjusted for prognostic parameters. These associations were expressed as adjusted common odds ratios (acOR).RESULTS: Vessel perforation occurred in 74 (2.6\%) of 2794 patients who underwent EVT. Female sex (aOR 2.0 (95\% CI 1.2-3.2)) and distal occlusion locations (aOR 2.2 (95\% CI 1.3-3.5)) were associated with increased risk of vessel perforation. Functional outcome was worse in patients with vessel perforation (acOR 0.38 (95\% CI 0.23-0.63)) compared to patients without a vessel perforation. No significant association was found between location of perforation and functional outcome.CONCLUSION: The incidence of vessel perforation during EVT in this cohort was low, but has severe clinical consequences. Female patients and patients treated at distal occlusion locations are at higher risk.",

keywords = "Humans, Female, Stroke, Ischemic Stroke/etiology, Brain Ischemia/etiology, Treatment Outcome, Endovascular Procedures/adverse effects, Thrombectomy/methods, Vessel perforation, Complications, Adverse effects, Ischemic stroke, Thrombectomy, Determinants",

author = "\{van der Sluijs\}, \{P. Matthijs\} and Ruisheng Su and S.A.P. Cornelissen and \{van Es\}, \{Adriaan C.G.M.\} and \{Lycklama {\`a} Nijeholt\}, \{Geert J.\} and B. Roozenbeek and \{van Doormaal\}, P.J. and J. Hofmeijer and \{van der Lugt\}, A. and \{van Walsum\}, T. and \{MR CLEAN Registry investigators\}",

year = "2024",

month = feb,

doi = "10.1007/s00234-023-03246-2",

language = "English",

volume = "66",

pages = "237--247",

journal = "Neuroradiology",

issn = "0028-3940",

publisher = "Springer",

number = "2",

}

van der Sluijs, PM, Su, R, Cornelissen, SAP, van Es, ACGM, Lycklama à Nijeholt, GJ, Roozenbeek, B, van Doormaal, PJ, Hofmeijer, J, van der Lugt, A, van Walsum, T & MR CLEAN Registry investigators 2024, 'Clinical consequence of vessel perforations during endovascular treatment of acute ischemic stroke', Neuroradiology, vol. 66, no. 2, pp. 237-247. https://doi.org/10.1007/s00234-023-03246-2

TY - JOUR

T1 - Clinical consequence of vessel perforations during endovascular treatment of acute ischemic stroke

AU - van der Sluijs, P. Matthijs

AU - Su, Ruisheng

AU - Cornelissen, S.A.P.

AU - van Es, Adriaan C.G.M.

AU - Lycklama à Nijeholt, Geert J.

AU - Roozenbeek, B.

AU - van Doormaal, P.J.

AU - Hofmeijer, J.

AU - van der Lugt, A.

AU - van Walsum, T.

AU - MR CLEAN Registry investigators

PY - 2024/2

Y1 - 2024/2

N2 - PURPOSE: Endovascular treatment (EVT) of acute ischemic stroke can be complicated by vessel perforation. We studied the incidence and determinants of vessel perforations. In addition, we studied the association of vessel perforations with functional outcome, and the association between location of perforation on digital subtraction angiography (DSA) and functional outcome, using a large EVT registry.METHODS: We included all patients in the MR CLEAN Registry who underwent EVT. We used DSA to determine whether EVT was complicated by a vessel perforation. We analyzed the association with baseline clinical and interventional parameters using logistic regression models. Functional outcome was measured using the modified Rankin Scale at 90 days. The association between vessel perforation and angiographic imaging features and functional outcome was studied using ordinal logistic regression models adjusted for prognostic parameters. These associations were expressed as adjusted common odds ratios (acOR).RESULTS: Vessel perforation occurred in 74 (2.6%) of 2794 patients who underwent EVT. Female sex (aOR 2.0 (95% CI 1.2-3.2)) and distal occlusion locations (aOR 2.2 (95% CI 1.3-3.5)) were associated with increased risk of vessel perforation. Functional outcome was worse in patients with vessel perforation (acOR 0.38 (95% CI 0.23-0.63)) compared to patients without a vessel perforation. No significant association was found between location of perforation and functional outcome.CONCLUSION: The incidence of vessel perforation during EVT in this cohort was low, but has severe clinical consequences. Female patients and patients treated at distal occlusion locations are at higher risk.

AB - PURPOSE: Endovascular treatment (EVT) of acute ischemic stroke can be complicated by vessel perforation. We studied the incidence and determinants of vessel perforations. In addition, we studied the association of vessel perforations with functional outcome, and the association between location of perforation on digital subtraction angiography (DSA) and functional outcome, using a large EVT registry.METHODS: We included all patients in the MR CLEAN Registry who underwent EVT. We used DSA to determine whether EVT was complicated by a vessel perforation. We analyzed the association with baseline clinical and interventional parameters using logistic regression models. Functional outcome was measured using the modified Rankin Scale at 90 days. The association between vessel perforation and angiographic imaging features and functional outcome was studied using ordinal logistic regression models adjusted for prognostic parameters. These associations were expressed as adjusted common odds ratios (acOR).RESULTS: Vessel perforation occurred in 74 (2.6%) of 2794 patients who underwent EVT. Female sex (aOR 2.0 (95% CI 1.2-3.2)) and distal occlusion locations (aOR 2.2 (95% CI 1.3-3.5)) were associated with increased risk of vessel perforation. Functional outcome was worse in patients with vessel perforation (acOR 0.38 (95% CI 0.23-0.63)) compared to patients without a vessel perforation. No significant association was found between location of perforation and functional outcome.CONCLUSION: The incidence of vessel perforation during EVT in this cohort was low, but has severe clinical consequences. Female patients and patients treated at distal occlusion locations are at higher risk.

KW - Humans

KW - Female

KW - Stroke

KW - Ischemic Stroke/etiology

KW - Brain Ischemia/etiology

KW - Treatment Outcome

KW - Endovascular Procedures/adverse effects

KW - Thrombectomy/methods

KW - Vessel perforation

KW - Complications

KW - Adverse effects

KW - Ischemic stroke

KW - Thrombectomy

KW - Determinants

UR - https://www.scopus.com/pages/publications/85178095785

U2 - 10.1007/s00234-023-03246-2

DO - 10.1007/s00234-023-03246-2

M3 - Article

C2 - 38010403

SN - 0028-3940

VL - 66

SP - 237

EP - 247

JO - Neuroradiology

JF - Neuroradiology

IS - 2

ER -

Clinical consequence of vessel perforations during endovascular treatment of acute ischemic stroke

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Keywords

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