2026-04-17T01:13:54Zhttps://recercat.cat/oai/request

oai:recercat.cat:11351/129952025-10-24T10:29:49Zcom_2072_378070com_2072_378040col_2072_378092

Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis Schulze-Zachau, Victor Rommers, Nikki Ntoulias, Nikolaos Krug, Nadja Tsogkas, Ioannis Brehm, Alex Requena, Manuel Rodrigo-Gisbert, Marc Institut Català de la Salut [Schulze-Zachau V, Ntoulias N, Brehm A, Krug N, Tsogkas I] Department of Diagnostic & Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland. [Rommers N] Clinical Research Department, University Basel, Basel, Switzerland. [Requena M] Secció de Neurorradiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Rodrigo-Gisbert M] Servei de Neurologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain Vall d'Hebron Barcelona Hospital Campus Vasos sanguinis - Cirurgia - Complicacions Teràpia trombolítica ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Vascular Surgical Procedures::Thrombectomy Other subheadings::Other subheadings::Other subheadings::/adverse effects DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Intraoperative Complications ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Drug Therapy::Thrombolytic Therapy TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos cardiovasculares::procedimientos quirúrgicos vasculares::trombectomía Otros calificadores::Otros calificadores::Otros calificadores::/efectos adversos ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::complicaciones intraoperatorias TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::farmacoterapia::tratamiento trombolítico Intracranial hemorrhage; Intraoperative; Thrombectomy Hemorràgia intracranial; Intraoperatori; Trombectomia Hemorragia intracraneal; Intraoperatorio; Trombectomía 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. 2025-04-25T10:40:26Z 2025-04-25T10:40:26Z 2025-03 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Schulze-Zachau V, Rommers N, Ntoulias N, Brehm A, Krug N, Tsogkas I, et al. “Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis.” Eur Stroke J. 2025 Mar;10(1):63-73. 1578-1283 http://hdl.handle.net/11351/12995 10.1177/23969873241272542 39171391 001430189200001 http://hdl.handle.net/11351/12995 eng European Stroke Journal;10(1) https://doi.org/10.1177/23969873241272542 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess application/pdf SAGE Publications Scientia