Complications During Mechanical Thrombectomy: Pitfalls and Bailouts

Khatri, Rakesh; Maud, Alberto; Rodríguez, Gustavo J.

doi:10.1007/978-3-030-17535-1_14

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…The large clinical trials on MT reported embolization to different arterial territories in around 6% of cases. 93 The mechanism of additional embolization in MT is usually caused by fragmentation of the clot during stent retrieval. In some cases, recanalization of these additional occlusions can be achieved by further MT passes or the administration of intra-arterial thrombolysis.…”

Section: Left Ventricular Thrombusmentioning

confidence: 99%

Short-Term Outcome and In-Hospital Complications After Acute Cerebral Infarcts in Multiple Arterial Territories

Novotný

Khanevski

Bjerkreim

et al. 2019

Stroke

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Background and Purpose— Patients with acute cerebral infarcts in multiple arterial territories (MACI) represent a substantial portion of the stroke population. There are no data on short-term outcome and in-hospital complications in patients with MACI. We compared patients with MACI with patients having acute cerebral infarct(s) in a single arterial territory. Methods— We analyzed 3343 patients with diffusion-weighted imaging-confirmed acute cerebral infarcts. MACI was defined as at least 2 acute cerebral ischemic lesions in at least 2 arterial cerebral territories. Patients with MACI were compared with patients with acute cerebral infarct(s) in a single arterial territory for relevant in-hospital complications and short-term outcome, namely National Institutes of Health Stroke Scale and modified Rankin Scale at day 7 after admission or at discharge when earlier. Results— A total of 311 patients (9.3%) met the definition of MACI. Both median National Institutes of Health Stroke Scale (2 [1–7] versus 1 [0–4]) and modified Rankin Scale (3 [1–4] versus 2 [1–3]) were higher in patients with MACI. MACI was independently associated with higher National Institutes of Health Stroke Scale and modified Rankin Scale. Deep venous thrombosis, myocardial infarction, and any complications were more frequent in patients with MACI. Conclusions— In-hospital complications were more frequent in patients with MACI, which may adversely affect short-term clinical and functional outcome. Closer follow-up of patients with MACI during hospitalization may prevent such events and negative progression.

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Section: Left Ventricular Thrombusmentioning

confidence: 99%

Short-Term Outcome and In-Hospital Complications After Acute Cerebral Infarcts in Multiple Arterial Territories

Novotný

Khanevski

Bjerkreim

et al. 2019

Stroke

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“…16 Complications can be classified in two categories: 1) intraprocedural complications, which can be further divided into access-and device-related difficulties and 2) postprocedural complications, mainly related with intracranial ischemic and haemorrhagic complications. 17,18 Access site complications comprise femoral artery dissection, pseudoaneurysm, arteriovenous fistula, retroperitoneal hematoma, acute lower limb ischemia, neuropathies and site infection. Device-related complications include artery dissection, vasospasm, vessel perforation, stent detachment, carotidcavernous fistula, embolization within the same or a new vascular territory and reocclusion.…”

Section: Discussionmentioning

confidence: 99%

“…Symptomatic intracranial hemorrhage, subarachnoid hemorrhage, reperfusion injury and cerebral edema are the most common postprocedural complications. [16][17][18] To achieve clot retrieval, MT can be performed with different techniques and similar efficacy and safety: mainly stent retrievers, aspiration catheters or a combination of both. 15 Animal histopathological data have raised concern about the local effects of endovascular manipulation with these devices in intracranial vessel walls.…”

Section: Discussionmentioning

confidence: 99%

Orbital inflammatory syndrome after mechanical thrombectomy of acute carotid occlusion

Silva¹,

Costa²,

Pinto³

et al. 2022

JNSK

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Introduction: Orbital ischemic syndrome (OIS) is a rare disorder that presents with acute loss of visual acuity, chemosis, proptosis, ptosis and ophtalmoparesis. We present a case with acute onset of orbital inflammation following mechanical thrombectomy that mimicked an OIS, except for the absence of vision loss. Case report: A 65-year-old woman presented to our emergency department after an episode of transient dysarthria and left-sided hemiparesis and paresthesia that lasted about forty minutes. Head computed tomography showed no signs of intracranial bleeding or acute ischemia. CT angiogram showed occlusion of the right ICA terminus. Mechanical thrombectomy was then performed and the clot was removed with combined technique. Eight hours later, she developed orbital pain, ptosis, chemosis and complete ophthalmoplegia of the right eye. She had no diplopia, visual acuity and funduscopic examination were normal and there was no audible bruit in the orbit. Brain MRI performed showed hyperintensity of orbital fat along with hyperintensity and enlargement of all the extraocular There were no signs of orbital infarction and the optic nerve was structurally normal. Time of flight magnetic resonance angiography revealed reduced calibre of the distal portion of ICA, with associated contrast enhancement on vessel wall imaging. She was started on intravenous dexamethasone with full recovery two days later. Discussion: We present the case of an orbital inflammatory syndrome after mechanical thrombectomy. The mechanical stress exerted by endovascular devices has been associated with endothelial damage that correlates with vessel wall thickening and contrast enhancement in high resolution MRI studies. The temporal correlation with mechanical thrombectomy, the absence of vision loss or orbital infarction and the good clinical response to steroids support the hypothesis of an internal carotid artery wall inflammation due to endovascular manipulation of the stent retriever to be responsible for this acute orbital syndrome. This case highlights the need for close postprocedural monitoring after MT and the consideration of orbital inflammation secondary to endovascular devices in the differential diagnosis of an acute orbital syndrome. Further studies are needed to understand the long-term consequences of arterial wall lesions associated with these devices.

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“…Some previous studies found that patients with bridging therapy have a better functional outcome, 29 while others have suggested that bridging therapy does not improve functional outcome over EVT alone. 30 Our study suggests that: the administration of IVT in patients that are far from a CSC is important and may lead to a better functional outcome of these patients; and repeated imaging in the CSC might reduce futile transfers to the angio-suite for EVT (and thus, invasive angiographic imaging and associated procedural risks 9 ) and improve efficient use of resources. Therefore, early recanalization might be relevant when designing the treatment workflow of patients who are considered for transfer to a CSC.…”

Section: Ischemic Strokementioning

confidence: 94%

“…7 8 In addition, identifying early recanalization might reduce futile preparation for EVT procedures and the related invasive angiography imaging, procedural risks (such as arterial dissections), and costs. 9 The goal of our study is to identify patient and thrombus characteristics that are associated with early recanalization. Therefore, we compare patient characteristics and quantify thrombus characteristics on pre-IVT CT imaging data of early recanalized LVO (ER-LVO) and non-early recanalized LVO (NER-LVO) patients.…”

Section: Introductionmentioning

confidence: 99%

Early recanalization in large-vessel occlusion stroke patients transferred for endovascular treatment

Terreros

Bruggeman

Swijnenburg

et al. 2021

J NeuroIntervent Surg

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BackgroundWe performed an exploratory analysis to identify patient and thrombus characteristics associated with early recanalization in large-vessel occlusion (LVO) stroke patients transferred for endovascular treatment (EVT) from a primary (PSC) to a comprehensive stroke center (CSC).MethodsWe included patients with an LVO stroke of the anterior circulation who were transferred to our hospital for EVT and underwent repeated imaging between January 2016 and June 2019. We compared patient characteristics, workflow time metrics, functional outcome (modified Rankin Scale at 90 days), and baseline thrombus imaging characteristics, which included: occlusion location, thrombus length, attenuation, perviousness, distance from terminus of intracranial carotid artery to the thrombus (DT), and clot burden score (CBS), between early-recanalized LVO (ER-LVO), and non-early-recanalized LVO (NER-LVO) patients.ResultsOne hundred and forty-nine patients were included in the analysis. Early recanalization occurred in 32% of patients. ER-LVO patients less often had a medical history of hypertension (31% vs 49%, P=0.04), and more often had clinical improvement between PSC and CSC (ΔNIHSS −5 vs 3, P<0.01), compared with NER-LVO patients. Thrombolysis administration was similar in both groups (88% vs 78%, P=0.18). ER-LVO patients had no ICA occlusions (0% vs 27%, P<0.01), more often an M2 occlusion (35% vs 17%, P=0.01), longer DT (27 mm vs 12 mm, P<0.01), shorter thrombi (17 mm vs 27 mm, P<0.01), and higher CBS (8 vs 6, P<0.01) at baseline imaging. ER-LVO patients had lower mRS scores (1 vs 3, P=0.02).ConclusionsEarly recanalization is associated with clinical improvement between PSC and CSC admission, more distal occlusions and shorter thrombi at baseline imaging, and better functional outcome.

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Complications During Mechanical Thrombectomy: Pitfalls and Bailouts

Cited by 4 publications

References 23 publications

Short-Term Outcome and In-Hospital Complications After Acute Cerebral Infarcts in Multiple Arterial Territories

Short-Term Outcome and In-Hospital Complications After Acute Cerebral Infarcts in Multiple Arterial Territories

Orbital inflammatory syndrome after mechanical thrombectomy of acute carotid occlusion

Early recanalization in large-vessel occlusion stroke patients transferred for endovascular treatment

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