“Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis”
Authors: Schulze-Zachau Victor , Rommers Nikki , Ntoulias Nikolaos , Brehm Alex , Krug Nadja , Tsogkas Ioannis , Mutke Matthias , Rusche Thilo , Cervo Amedeo , Rollo Claudia , Möhlenbruch Markus , Jesser Jessica , Kreiser Kornelia , Althaus Katharina , Requena Manuel , Rodrigo-Gisbert Marc , Dobrocky Tomas , Serrallach Bettina L , Nolte Christian H , Riegler Christoph , Nawabi Jawed , Maslias Errikos , Michel Patrik , Saliou Guillaume , Manning Nathan , McQuinn Alexander , Taylor Alon , Maurer Christoph J , Berlis Ansgar , Kaiser Daniel PO , Cuberi Ani , Moreu Manuel , López-Frías Alfonso , Pérez-García Carlos , Rautio Riitta , Pauli Ylikotila , Limbucci Nicola , Renieri Leonardo , Fragata Isabel , Rodriguez-Ares Tania , Kirschke Jan S , Schwarting Julian , Al Kasab Sami , Spiotta Alejandro M , Abu Qdais Ahmad , Dmytriw Adam A , Regenhardt Robert W , Patel Aman B , Pereira Vitor Mendes , Cancelliere Nicole M , Schmeel Carsten , Dorn Franziska , Sauer Malte , Karwacki Grzegorz M , Khalife Jane , Thomas Ajith J , Shaikh Hamza A , Commodaro Christian , Pileggi Marco , Schwab Roland , Bellante Flavio , Dusart Anne , Hofmeister Jeremy , Machi Paolo , Samaniego Edgar A , Ojeda Diego J , Starke Robert M , Abdelsalam Ahmed , van den Bergh Frans , De Raedt Sylvie , Bester Maxim , Flottmann Fabian , Weiss Daniel , Kaschner Marius , Kan Peter T , Edhayan Gautam , Levitt Michael R , Raub Spencer L , Katan Mira , Fischer Urs , Psychogios Marios-Nikos 
Published: August 2024

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.