Vessel perforation during stent retriever thrombectomy for acute ischemic stroke: technical details and clinical outcomes.
BACKGROUND
Vessel perforation during stent retriever thrombectomy is a rare complication; typically only single instances have been reported.


OBJECTIVE
To report on a series of patients whose stent retriever thrombectomy was complicated by intraprocedural vessel perforation and discuss its potential mechanisms, rescue treatment strategies, and clinical significance.


METHODS
Cases with intraprocedural vessel perforation, where a stent retriever was used either as a primary treatment approach or as a part of a direct aspiration first pass technique (ADAPT), were included in the final analysis. Clinical data, procedural details, radiographic and clinical outcomes were collected from nine participating centers.


RESULTS
Intraprocedural vessel perforation during stent retriever thrombectomy occurred in 16 (1.0%) of 1599 cases. 63% of intraprocedural perforations occurred at distal locations. Endovascular rescue techniques (most commonly, intracranial balloon occlusion for tamponade) were attempted in 50% of cases. Procedure was aborted without any rescue attempts in 44% of cases. Mortality during hospitalization and at 3 months was 56% and 63%, respectively. 25% of patients achieved good functional outcome at 3 months after the procedure.


CONCLUSIONS
Intraprocedural perforations during stent retriever thrombectomy were rare, but when they occurred were associated with high mortality. Perforations most commonly occurred at distal occlusion sites and were often characterized by difficulty traversing the occlusion with a microcatheter or microwire, or while withdrawing the stent retriever. Nevertheless, 25% of patients had a favorable functional outcome, suggesting that in some patients with this complication good neurological recovery is achievable.
Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
Maxim
http://orcid.org/0000-0001-7264-4233
M
Mokin
Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA.
Kyle M
KM
Fargen
Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
Christopher T
CT
Primiani
Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
Zeguang
Z
Ren
Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona, USA.
Travis M
TM
Dumont
Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona, USA.
Leonardo B C
LBC
Brasiliense
Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, Florida, USA.
Guilherme
G
Dabus
Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, Florida, USA.
Italo
I
Linfante
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Peter
P
Kan
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Visish M
VM
Srinivasan
Drexel Neurosciences Institute, Philadelphia, Pennsylvania, USA.
Mandy J
MJ
Binning
Wellstar Neurosurgery, Marietta, Georgia, USA.
Rishi
R
Gupta
Medical University of South Carolina, Charleston, South Carolina, USA.
Aquilla S
AS
Turk
Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
Lucas
L
Elijovich
Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
Adam
A
Arthur
Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA.
Hussain
H
Shallwani
Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA.
Elad I
EI
Levy
Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA.
Adnan H
AH
Siddiqui
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
Stroke; Subarachnoid; Thrombectomy