Iatrogenic Vessel Dissection in Endovascular Treatment of Acute Ischemic Stroke

Simonetti, Barbara Goeggel; Hulliger, Justine; Mathier, Etienne; Jung, Simon; Fischer, Urs; Sarıkaya, Hakan; Slotboom, Johannes; Schroth, Gerhard; Mordasini, Pasquale; Gralla, Jan; Arnold, Marcel

doi:10.1007/s00062-017-0639-z

Cited by 36 publications

(29 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The rate of complications in patients with NIHSS < 8 was comparable to recent meta-analysis data [20] and matches the frequency of complications observed in patients presenting with NIHSS ≥ 8 in this registry. Two-thirds of complications were comprised by iatrogenic cervical dissections and periprocedural vasospasms, both associated with relatively low risk of prompting unfavorable outcomes [21]. When adjusting for the lower rates of successful reperfusion in patients with procedural complications, we did not observe an independent effect of complications on outcome (data not shown).…”

Section: Discussionmentioning

confidence: 86%

See 1 more Smart Citation

Clinical effect of successful reperfusion in patients presenting with NIHSS < 8: data from the BEYOND-SWIFT registry

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background and purpose If patients presenting with large vessel occlusions (LVO) and mild symptoms should be treated with endvoascular treatment (EVT) remains unclear. Aims of this study were (1) assessing the safety and technical efficacy of EVT in patients with NIHSS < 8 as opposed to a comparison group of patients presenting with NIHSS ≥ 8 and (2) evaluation of the clinical effect of reperfusion in patients with NIHSS < 8. Methods Patients included into the retrospective multicenter BEYOND-SWIFT registry (NCT03496064) were analyzed. Clinical effect of achieving successful reperfusion (defined as modified Thrombolysis in Cerebral Infarction grade 2b/3) in patients presenting with NIHSS < 8 ( N = 193) was evaluated using multivariable logistic regression analyses (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI). Primary outcome was excellent functional outcome (modified Rankin Scale, mRS 0–1) at day 90. Safety and efficacy of mechanical thrombectomy in patients with NIHSS < 8 was compared to patients presenting with NIHSS ≥ 8 ( N = 1423). Results Among patients with NIHSS < 8 ( N = 193, 77/193, 39.9% receiving pre-interventional IV-tPA), successful reperfusion was significantly related to mRS 0–1 (aOR 3.217, 95%-CI 1.174–8.816) and reduced the chances of non-hemorrhagic neurological worsening (aOR 0.194, 95%-CI 0.050–0.756) after adjusting for prespecified confounders. In interaction analyses, the relative merits of achieving successful reperfusion were mostly comparable between patients presenting with NIHSS < 8 and NIHSS ≥ 8 as evidenced by non-significantly different aOR. Interventional safety and efficacy metrics were similar between patients with NIHSS < 8 and NIHSS ≥ 8. Conclusions Achieving successful reperfusion is beneficial in patients with persisting LVO presenting with NIHSS < 8 and reduces the risk of non-hemorrhagic neurological worsening. Electronic supplementary material The online version of this article (10.1007/s00415-018-09172-1) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 86%

“…While a proportion of patients will most likely benefit from routine EVT by preventing infarct growth, EVT also harbors the risk of worsening cerebral perfusion by thrombus dislocation and subsequent collateral shutdown and other procedural complications [20] (e.g. dissection [21], perforation [22], infarct to new territory [23], etc. ).…”

Section: Introductionmentioning

confidence: 99%

Clinical effect of successful reperfusion in patients presenting with NIHSS < 8: data from the BEYOND-SWIFT registry

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…It has been reported that iatrogenic vessel dissection occurs in 0.6%-3.9% of mechanical thrombectomy cases [11] , [12] , [13] . Among these cases, extracranial dissection was more common, whereas intracranial vessel dissection was precisely described in only a small number [11 , 17] . Among approximately 250 cases of mechanical thrombectomy at our institute over the past 5 years, only these 2 patients were definitively diagnosed with iatrogenic intracranial dissection (0.8%) [20] , [21] , [22] , [23] .…”

Section: Discussionmentioning

confidence: 99%

“…In both cases, dissection occurred at the initially nonoccluded but mildly arteriosclerotic M1, where a large-bore aspiration catheter shifted up into the distal vessel through the atherosclerotic lesion. Among the few previous reports of intracranial vessel dissection during mechanical thrombectomy, the aspiration catheter was reported as the estimated cause of dissection [17] . Various large-bore aspiration catheters for mechanical thrombectomy have been developed and are now widely used with contact aspiration or an SR and aspiration catheter combined.…”

Section: Discussionmentioning

confidence: 99%

“…Vessel perforation is usually noticed as an obvious protrusion of a device from the vascular structure, or is visualized as a contrast leak at the distal site of the manipulation. Improper mechanical thrombectomy procedures can also cause vessel dissection, another type of vessel injury [17] , [18] , [19] . Unlike vessel perforation, vessel dissection is not always apparent on subsequent angiography and can occur at any procedural site without the obvious protrusion of a device from a vascular structure.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Iatrogenic intracranial vessel dissection during mechanical thrombectomy rescued by emergent stenting: 2 case reports

Nakahara

Imahori

Tanaka

et al. 2021

Radiology Case Reports

View full text Add to dashboard Cite

Intracranial vessel dissection is a procedural complication associated with endovascular treatment. However, there have been few reports on its potential causes and management during mechanical thrombectomy. In approximately 250 cases of mechanical thrombectomy over the past 5 years at our institution, iatrogenic intracranial dissection occurred in 2 patients (0.8%). In this report, we described these 2 cases that were rescued through emergent stenting. Mechanical thrombectomy, using both a stent retriever and an aspiration catheter, was performed for acute middle cerebral artery M2 occlusion in Patient 1 (a 69-year-old man) and for distal M1 occlusion in Patient 2 (an 83-year-old woman). In both cases, recanalization was achieved with the procedure, but irregular stenosis developed at the initially nonoccluded, but mildly arteriosclerotic, M1, after recanalization. During the thrombectomy procedure, the aspiration catheter sifted up to the arteriosclerotic M1. In both cases, the lesions were considered vessel dissection, due to a shift of the aspiration catheter tip into the arteriosclerotic vessel wall. Repeated percutaneous angiography with antithrombotic therapy failed to improve the lesions and to maintain the antegrade blood flow. Finally, lesions in each patient were successfully rescued through the use of emergent stenting. A drug-eluting stent for coronary use was deployed in Patient 1, and an Enterprise stent was applied in Patient 2. Inadvertent shift of the aspiration catheter into arteriosclerotic vessels can cause a serious intracranial vessel dissection. When performing mechanical thrombectomy, intracranial stents need to be available as rescue treatment devices to manage refractory iatrogenic intracranial vessel dissection.

show abstract

Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke

et al. 2021

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Clinical evidence of the potential treatment benefit of mechanical thrombectomy for posterior circulation distal, medium vessel occlusion (DMVO) is sparse.OBJECTIVE To investigate the frequency as well as the clinical and safety outcomes of mechanical thrombectomy for isolated posterior circulation DMVO stroke and to compare them with the outcomes of standard medical treatment with or without intravenous thrombolysis (IVT) in daily clinical practice. DESIGN, SETTING, AND PARTICIPANTSThis multicenter case-control study analyzed patients who were treated for primary distal occlusion of the posterior cerebral artery (PCA) of the P2 or P3 segment. These patients received mechanical thrombectomy or standard medical treatment (with or without IVT) at 1 of 23 comprehensive stroke centers in Europe, the United States, and Asia between January 1, 2010, and June 30, 2020. All patients who met the inclusion criteria were matched using 1:1 propensity score matching. INTERVENTIONS Mechanical thrombectomy or standard medical treatment with or without IVT.MAIN OUTCOMES AND MEASURES Clinical end point was the improvement of National Institutes of Health Stroke Scale (NIHSS) scores at discharge from baseline. Safety end point was the occurrence of symptomatic intracranial hemorrhage and hemorrhagic complications were classified based on the Second European-Australasian Acute Stroke Study (ECASSII). Functional outcome was evaluated with the modified Rankin Scale (mRS) score at 90-day follow-up. RESULTSOf 243 patients from all participating centers who met the inclusion criteria, 184 patients were matched. Among these patients, the median (interquartile range [IQR]) age was 74 (62-81) years and 95 (51.6%) were female individuals. Posterior circulation DMVOs were located in the P2 segment of the PCA in 149 patients (81.0%) and in the P3 segment in 35 patients (19.0%). At discharge, the mean NIHSS score decrease was −2.4 points (95% CI, −3.2 to −1.6) in the standard medical treatment cohort and −3.9 points (95% CI, −5.4 to −2.5) in the mechanical thrombectomy cohort, with a mean difference of −1.5 points (95% CI, 3.2 to −0.8; P = .06). Significant treatment effects of mechanical thrombectomy were observed in the subgroup of patients who had higher NIHSS scores on admission of 10 points or higher (mean difference, −5.6; 95% CI, −10.9 to −0.2; P = .04) and in the subgroup of patients without IVT (mean difference, −3.0; 95% CI, −5.0 to −0.9; P = .005). Symptomatic intracranial hemorrhage occurred in 4 of 92 patients (4.3%) in each treatment cohort.CONCLUSIONS AND RELEVANCE This study suggested that, although rarely performed at comprehensive stroke centers, mechanical thrombectomy for posterior circulation DMVO is a safe, and technically feasible treatment option for occlusions of the P2 or P3 segment of the PCA compared with standard medical treatment with or without IVT.

show abstract

Iatrogenic Vessel Dissection in Endovascular Treatment of Acute Ischemic Stroke

Cited by 36 publications

References 30 publications

Clinical effect of successful reperfusion in patients presenting with NIHSS < 8: data from the BEYOND-SWIFT registry

Clinical effect of successful reperfusion in patients presenting with NIHSS < 8: data from the BEYOND-SWIFT registry

Iatrogenic intracranial vessel dissection during mechanical thrombectomy rescued by emergent stenting: 2 case reports

Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke

Contact Info

Product

Resources

About