Thrombectomy Complications in Large Vessel Occlusions: Incidence, Predictors, and Clinical Impact in the ETIS Registry
Authors: Happi Ngankou Emmanuel , Gory Benjamin , Marnat Gaultier , Richard Sébastien , Bourcier Romain , Sibon Igor , Dargazanli Cyril , Arquizan Caroline , Maïer Benjamin , Blanc Raphaël , Lapergue Bertrand , Consoli Arturo , Vannier Stéphane , Spelle Laurent , Denier Christian , Boulanger Marion , Gauberti Maxime , Saleme Suzana , Macian Francisco , Clarençon Frédéric , Rosso Charlotte , Naggara Olivier , Turc Guillaume , Ozkul-Wermester Ozlem , Papagiannaki Chrysanthi , Viguier Alain , Cognard Christophe , Lebras Anthony , Evain Sarah , Wolff Valérie , Pop Raoul , Timsit Serge , Gentric Jean-Christophe , Bourdain Frédéric , Veunac Louis , Eugène François , Finitsis Stephanos , Piotin Michel , Redjem Hocine , Escalard Simon , Dessilles Jean-Philippe , Delvoye François , Smajda Stanislas , Solène Hebert , Mazighi Mikael , Obadia Mikael , Sabben Candice , Seners Pierre , Raynouard Igor , Corabianu Ovide , de Broucker Thomas , Manchon Eric , Taylor Guillaume , Maacha Malek Ben , Thion Laurie-Anne , Lecler Augustin , Savatovsjy Julien , Wang Adrien , Evrard Serge , Tchikviladze Maya , Ajili Nadia , WeisenburgerLile David , Gorza Lucas , Buard Géraldine , Coskun Oguzhan , Di Maria Federico , Rodesh Georges , Zimatore Sergio , Leguen Morgan , Gratieux Julie , Pico Fernando , Rakotoharinandrasana Haja , Tassan Philippe , Poll Roxanna , Marinier Sylvie , Gariel Florent , Barreau Xavier , Berge Jérôme , Menegon Patrice , Lucas Ludovic , Olindo Stéphane , Renou Pauline , Sagnier Sharmila , Poli Mathilde , Debruxelles Sabrina , Rouanet François , Tourdias Thomas , Liegey Jean-Sebastien , Briau Pierre , Pangon Nicolas , Detraz Lili , Daumas-Duport Benjamin , Alexandre Pierre-Louis , Roy Monica , Lenoble Cédric , Desal Hubert , Guillon Benoît , de Gaalon Solène , Preterre Cécile , Bracard Serge , Anxionnat René , Braun Marc , Derelle Anne-Laure , Liao Liang , Zhu François , Schmitt Emmanuelle , Planel Sophie , Humbertjean Lisa , Mione Gioia , Lacour Jean-Christophe , Riou-Comte Nolwenn , Audibert Gérard , Voicu Marcela , Alb Lionel , Reitter Marie , Brezeanu Madalina , Masson Agnès , Tabarna Adriana , Podar Iona , Guy Sarah , Bechiri Fatiha , Bourst Pauline , Mounayer Charbel , Rouchaud Aymeric , Gimenez Laetitia , Cosnard Alexandre , Costalat Vincent , Gascou Grégory , Lefèvre Pierre-Henri , Derraz Imad , Riquelme Carlos , Gaillard Nicolas , Mourand Isabelle , Corti Lucas , Cagnazzo Federico , ter Schiphorst Adrien , Ferre Jean-Christophe , Raoult Hélène , Ronziere Thomas , Lassale Maria , Paya Christophe , Gauvrit Jean-Yves , Tracol Clément , Langnier-Lemercier Sophie , Maurice Axelle , Cochennec Sabrina , Pinault Mélanie , Shotar Eimad , Sourour Nader , Lenck Stéphanie , Premat Kévin , Léger Yves Samson Anne , Crozier Sophie , Baronnet Flore , Alamowitch Sonia , Bottin Laure , Yger Mathon , Degos Vincent , Chassin Olivier , Chalumeau Vanessa , Caroff Jildaz , Chassin Olivier , Venditti Laura , Sarov Mariana , Legris Nicolas , Hassen Wagih Ben , Boulouis Grégoire , Rodriguez-Régent Christine , Trystram Denis , Kerleroux Basile , Seners Pierre , Domigo Valérie , Lamy Catherine , Birchenall Julia , Isabel Clothilde , Lun François , Januel Anne Christine , Olivot Jean-Marc , Fontaine Louis , Raposo Nicolas , Bonneville Fabrice , Albucher Jean François , Calviere Lionel , Darcourt Jean , Bellanger Guillaume , Tall Philippe , Touze Emmanuel , Barbier Charlotte , Schneckenburger Romain , Cogez Julien , Guettier Sophie , Ognard Julien , Merrien Francois Mathias , Wermester Ozlem Ozku , Massardier Evelyne , Triquenot Aude , Lefebvre Margeaux , Bernady Patricia , Lagoarde-Segot Laurent , Cailliez Hélène , Higue David , Quenardelle Veronique , Lauer Valerie , Gheoca Roxana , Pierre-Paul Irene , Beaujeux Remy , Mihoc Dan , Manisor Monica , Pottecher Julien , Meyer Alain , Chamaraux-Tran Thiên-Nga , Le Bras Anthony , Le Guen Arnaud 
Published: October 2021

Background and Purpose:
Procedural complications in thrombectomy for large vessel occlusions of the anterior circulation are not well described. We investigated the incidence, risk factors, and clinical implications of thrombectomy complications in daily clinical practice.

Methods:
We used data from the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France. The present study is a retrospective analysis of 4029 stroke patients with anterior large vessel occlusions treated with thrombectomy between January 2015 and May 2020 in 18 centers. We systematically collected procedural data, incidence of embolic complications, perforations and dissections, clinical outcome at 90 days, and hemorrhagic complications.

Results:

Procedural complications occurred in 7.99% (95% CI, 7.17%–8.87%), and embolus to a new territory (ENT) was the most frequent (5.2%). Predictors of ENTs were terminal carotid/tandem occlusion (odds ratio [OR], 5 [95% CI, 2.03–12.31];
P
<0.001) and an increased total number of passes (OR, 1.22 [95% CI, 1.05–1.41];
P
=0.006). ENTs were associated to worse clinical outcomes (90-day modified Rankin Scale score, 0–2; adjusted OR, 0.4 [95% CI, 0.25–0.63];
P
<0.001), increased mortality (adjusted OR, 1.74 [95% CI, 1.2–2.53];
P
<0.001), and symptomatic intracerebral hemorrhage (adjusted OR, 1.87 [95% CI, 1.15–3.03];
P
=0.011). Perforations occurred in 1.69% (95% CI, 1.31%–2.13%). Predictors of perforations were terminal carotid/tandem occlusions (39.7% versus 27.6%;
P
=0.028). 40.7% of patients died at 90 days, and the overall rate of poor outcome was 74.6% in case of perforation. Dissections occurred in 1.46% (95% CI, 1.11%–1.88%) and were more common in younger patients (median age, 64.2 versus 70.2 years;
P
=0.002). Dissections did not affect the clinical outcome at 90 days. Besides dissection, complications were independent of the thrombectomy technique.

Conclusions:
Thrombectomy complication rate is not negligible, and ENTs were the most frequent. ENTs and perforations were associated with disability and mortality, and terminal carotid/tandem occlusions were a risk factor.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03776877.