Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study
Authors: Dmytriw Adam A , Musmar Basel , Salim Hamza , Ghozy Sherief , Siegler James E , Kobeissi Hassan , Shaikh Hamza , Khalife Jane , Abdalkader Mohamad , Klein Piers , Nguyen Thanh N , Heit Jeremy J , Regenhardt Robert W , Cancelliere Nicole M , Bernstock Joshua D , Naamani Kareem El , Amllay Abdelaziz , Meyer Lukas , Dusart Anne , Bellante Flavio , Forestier Géraud , Rouchaud Aymeric , Saleme Suzana , Mounayer Charbel , Fiehler Jens , Kühn Anna Luisa , Puri Ajit S , Dyzmann Christian , Kan Peter T , Colasurdo Marco , Marnat Gaultier , Berge Jérôme , Barreau Xavier , Sibon Igor , Nedelcu Simona , Henninger Nils , Marotta Thomas R , Stapleton Christopher J , Rabinov James D , Ota Takahiro , Dofuku Shogo , Yeo Leonard LL , Tan Benjamin YQ , Gopinathan Anil , Martinez-Gutierrez Juan Carlos , Salazar-Marioni Sergio , Sheth Sunil , Renieri Leonardo , Capirossi Carolina , Mowla Ashkan , Chervak Lina , Vagal Achala , Adeeb Nimer , Cuellar-Saenz Hugo H , Tjoumakaris Stavropoula I , Jabbour Pascal , Khandelwal Priyank , Biswas Arundhati , Clarençon Frédéric , Elhorany Mahmoud , Premat Kevin , Valente Iacopo , Pedicelli Alessandro , Filipe João Pedro , Varela Ricardo , Quintero-Consuegra Miguel , Gonzalez Nestor R , Möhlenbruch Markus A , Jesser Jessica , Costalat Vincent , ter Schiphorst Adrien , Yedavalli Vivek , Harker Pablo , Aziz Yasmin , Gory Benjamin , Stracke Christian Paul , Hecker Constantin , Kadirvel Ramanathan , Killer-Oberpfalzer Monika , Griessenauer Christoph J , Thomas Ajith J , Hsieh Cheng-Yang , Liebeskind David S , Alexandru Radu Răzvan , Alexandre Andrea M , Tancredi Illario , Faizy Tobias D , Fahed Robert , Weyland Charlotte , Lubicz Boris , Patel Aman B , Pereira Vitor Mendes , Guenego Adrien ,   for the MAD-MT Consortium
Published: February 2024

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.