Thrombectomy Complications in Large Vessel Occlusions: Incidence, Predictors, and Clinical Impact in the ETIS Registry
-
- Emmanuel Happi Ngankou
- Department of Diagnostic and Therapeutic Neuroradiology (E.H.N., B.G.), Université de Lorraine, CHRU-Nancy, France.
-
- Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology (E.H.N., B.G.), Université de Lorraine, CHRU-Nancy, France.
-
- Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, France (G.M.).
-
- Sébastien Richard
- Department of Neurology, Stroke Unit (S.R.), Université de Lorraine, CHRU-Nancy, France.
-
- Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, France (R.B.).
-
- Igor Sibon
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, France (I.S.).
-
- Cyril Dargazanli
- Department of Interventional Neuroradiology (C.D.), CHRU Gui de Chauliac, Montpellier, France.
-
- Caroline Arquizan
- Department of Neurology (C.A.), CHRU Gui de Chauliac, Montpellier, France.
-
- Benjamin Maïer
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (B.M., R.B.).
-
- Raphaël Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (B.M., R.B.).
-
- Bertrand Lapergue
- Department of Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France.
-
- Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology (A.C.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France.
-
- Stéphane Vannier
- Department of Neurology, Stroke Unit (S.V.), University Hospital of Rennes, France.
-
- Laurent Spelle
- Neuroradiolology (L.S.), CHU Kremlin Bicêtre, Paris, France.
-
- Christian Denier
- Departments of Neurology (C.D.), CHU Kremlin Bicêtre, Paris, France.
-
- Marion Boulanger
- Departments of Neurology (M.B.), CHU Caen, France.
-
- Maxime Gauberti
- Neuroradiolology (M.G.), CHU Caen, France.
-
- Suzana Saleme
- Department of Interventional Neuroradiology (S.S.), CHU Limoges, France.
-
- Francisco Macian
- Neurology, Stroke Unit (F.M.), CHU Limoges, France.
-
- Frédéric Clarençon
- Neuroradiolology (F.C.), CHU Pitié-Salpétrière, Paris, France.
-
- Charlotte Rosso
- Departments of Neurology (C.R.), CHU Pitié-Salpétrière, Paris, France.
-
- Olivier Naggara
- Neuroradiolology (O.N.), Hôpital Saint Anne, Paris, France.
-
- Guillaume Turc
- Departments of Neurology (G.T.), Hôpital Saint Anne, Paris, France.
-
- Ozlem Ozkul-Wermester
- Departments of Neurology (O.O.-W.), CHU Rouen, France.
-
- Chrysanthi Papagiannaki
- Neuroradiolology (C.P.), CHU Rouen, France.
-
- Alain Viguier
- Departments of Neurology (A.V.), CHU Toulouse, France.
-
- Christophe Cognard
- Neuroradiolology (C.C.), CHU Toulouse, France.
-
- Anthony Lebras
- Departments of Neurology (A.L.), CH Bretagne Atlantique, Vannes, France.
-
- Sarah Evain
- Neuroradiolology (S.E.), CH Bretagne Atlantique, Vannes, France.
-
- Valérie Wolff
- Departments of Neurology (V.W.), CHU Strasbourg, France.
-
- Raoul Pop
- Neuroradiolology (R.P.), CHU Strasbourg, France.
-
- Serge Timsit
- Departments of Neurology (S.T.), CHU Brest, France.
-
- Jean-Christophe Gentric
- Neuroradiolology (J.-C.G.), CHU Brest, France.
-
- Frédéric Bourdain
- Departments of Neurology (F.B.), CH Côte Basque, Bayonne, France.
-
- Louis Veunac
- Neuroradiolology (L.V.), CH Côte Basque, Bayonne, France.
-
- François Eugène
- Department of Neuroradiology (F.E.), University Hospital of Rennes, France.
-
- Stephanos Finitsis
- Ahepa Hospital, Aristotle University of Thessaloniki, Greece (S.F.).
抄録
<jats:sec> <jats:title>Background and Purpose:</jats:title> <jats:p>Procedural complications in thrombectomy for large vessel occlusions of the anterior circulation are not well described. We investigated the incidence, risk factors, and clinical implications of thrombectomy complications in daily clinical practice.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>We used data from the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France. The present study is a retrospective analysis of 4029 stroke patients with anterior large vessel occlusions treated with thrombectomy between January 2015 and May 2020 in 18 centers. We systematically collected procedural data, incidence of embolic complications, perforations and dissections, clinical outcome at 90 days, and hemorrhagic complications.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p> Procedural complications occurred in 7.99% (95% CI, 7.17%–8.87%), and embolus to a new territory (ENT) was the most frequent (5.2%). Predictors of ENTs were terminal carotid/tandem occlusion (odds ratio [OR], 5 [95% CI, 2.03–12.31]; <jats:italic>P</jats:italic> <0.001) and an increased total number of passes (OR, 1.22 [95% CI, 1.05–1.41]; <jats:italic>P</jats:italic> =0.006). ENTs were associated to worse clinical outcomes (90-day modified Rankin Scale score, 0–2; adjusted OR, 0.4 [95% CI, 0.25–0.63]; <jats:italic>P</jats:italic> <0.001), increased mortality (adjusted OR, 1.74 [95% CI, 1.2–2.53]; <jats:italic>P</jats:italic> <0.001), and symptomatic intracerebral hemorrhage (adjusted OR, 1.87 [95% CI, 1.15–3.03]; <jats:italic>P</jats:italic> =0.011). Perforations occurred in 1.69% (95% CI, 1.31%–2.13%). Predictors of perforations were terminal carotid/tandem occlusions (39.7% versus 27.6%; <jats:italic>P</jats:italic> =0.028). 40.7% of patients died at 90 days, and the overall rate of poor outcome was 74.6% in case of perforation. Dissections occurred in 1.46% (95% CI, 1.11%–1.88%) and were more common in younger patients (median age, 64.2 versus 70.2 years; <jats:italic>P</jats:italic> =0.002). Dissections did not affect the clinical outcome at 90 days. Besides dissection, complications were independent of the thrombectomy technique. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Thrombectomy complication rate is not negligible, and ENTs were the most frequent. ENTs and perforations were associated with disability and mortality, and terminal carotid/tandem occlusions were a risk factor.</jats:p> </jats:sec> <jats:sec> <jats:title>Registration:</jats:title> <jats:p> URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</jats:ext-link> ; Unique identifier: NCT03776877. </jats:p> </jats:sec>
収録刊行物
-
- Stroke
-
Stroke 52 (12), e764-, 2021-12
Ovid Technologies (Wolters Kluwer Health)