title: Groin complications in endovascular mechanical thrombectomy for acute ischemic stroke: a 10-year single center experience.
abstract: BACKGROUND
  The increasing utilization of balloon guide catheters (BGCs) in thrombectomy therapy for ischemic stroke has led to concerns about large-bore sheaths causing vascular groin complications.Objective To retrospectively assess the impact of large large-bore sheaths and vascular closure devices on groin complication rates at a comprehensive stroke center over a 10-year period.
  
  
  METHODS
  Radiological and clinical records of patients with acute ischemic stroke who underwent mechanical endovascular therapy with an 8Fr or larger sheaths were reviewed. A groin complication was defined as the formation of a groin hematoma, retroperitoneal hematoma, femoral artery pseudoaneurysm, or the need for surgical repair. Information collected included size of sheath, type of hemostatic device, and anticoagulation status of the patient. Blood bank records were also analyzed to identify patients who may have had an undocumented blood transfusion for a groin hematoma.
  
  
  RESULTS
  A total of 472 patients with acute ischemic stroke who underwent mechanical thrombectomy with a sheath and BGC sized 8Fr or larger were identified. 260 patients (55.1%) had tissue Plasminogen Activator (tPA) administered as part of stroke treatment. Vascular closure devices were used in 97.9% of cases (n=462). Two patients were identified who had definite groin complications and a further two were included as having possible complications. There was a very low rate of clinically significant groin complications (0.4-0.8%) associated with the use of large-bore sheaths.
  
  
  CONCLUSIONS
  These findings suggest that concerns for groin complications should not preclude the use of BGCs and large-bore sheaths in mechanical thrombectomy for acute ischemic stroke.
authors.affiliation: Marion Bloch Neuroscience Institute, St. Luke's Plaza, Kansas City, Missouri, USA.
authors.forename: Veer A
authors.initials: VA
authors.lastname: Shah
authors.affiliation: Marion Bloch Neuroscience Institute, St. Luke's Plaza, Kansas City, Missouri, USA.
authors.forename: Coleman O
authors.initials: CO
authors.lastname: Martin
authors.affiliation: Marion Bloch Neuroscience Institute, St. Luke's Plaza, Kansas City, Missouri, USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Hawkins
authors.affiliation: Marion Bloch Neuroscience Institute, St. Luke's Plaza, Kansas City, Missouri, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Holloway
authors.affiliation: University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Junna
authors.affiliation: Marion Bloch Neuroscience Institute, St. Luke's Plaza, Kansas City, Missouri, USA.
authors.forename: Naveed
authors.initials: N
authors.lastname: Akhtar
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000209:etiology / Q000628:therapy; D063125:Balloon Embolectomy; D002545:Brain Ischemia / Q000601:surgery*; D057785:Catheters / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006119:Groin / Q000601:surgery; D006406:Hematoma / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects* / Q000295:instrumentation; D065506:Vascular Closure Devices / Q000009:adverse effects
keywords: Balloon; Catheter; Complication; Stroke; Thrombectomy