Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke

Giancarlo Salsano, Giovanni Pracucci, Nicola Mavilio, Valentina Saia, Monica Bandettini di Poggio, Laura Malfatto, Fabrizio Sallustio, Andrea Wlderk, Nicola Limbucci, Patrizia Nencini, Stefano Vallone, Andrea Zini, Guido Bigliardi, Mariano Velo, Isabella Francalanza, Paola Gennari, Rossana Tassi, Mauro Bergui, Paolo Cerrato, Giuseppe CaritàCristiano Azzini, Roberto Gasparotti, Mauro Magoni, Salvatore Isceri, Christian Commodaro, Francesco Cordici, Roberto Menozzi, Lilia Latte, Mirco Cosottini, Michelangelo Mancuso, Alessio Comai, Enrica Franchini, Andrea Alexandre, Giacomo Della Marca, Edoardo Puglielli, Alfonsina Casalena, Francesco Causin, Claudio Baracchini, Luca Di Maggio, Andrea Naldi, Andrea Grazioli, Stefano Forlivesi, Luigi Chiumarulo, Marco Petruzzellis, Giuseppina Sanfilippo, Gianpaolo Toscano, Nicola Cavasin, Nunzio Paolo Nuzzi, Manuel Corato, Lucio Castellan

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes.

AIMS: We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications.

METHODS: From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected.

RESULTS: The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21-2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13-8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66-12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31-0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97-0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19-0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6-0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02-1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02-1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25-2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26-3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08-2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55-0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up.

CONCLUSIONS: Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits.

Original languageEnglish
Pages (from-to)1747493020976681
JournalInternational Journal of Stroke
DOIs
Publication statusE-pub ahead of print - Dec 6 2020

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