Maslias E, Puccinelli F, Nannoni S, Hajdu S D, Bartolini B, Ricciardi F, Dunet V, Maeder P, Strambo D, Saliou G, Michel P
From the Stroke Centre (E.M., S.N., D.S., P. Michel), Neurology Service, Department of Clinical Neurosciences
Department of Diagnostic and Interventional Radiology (F.P., S.D.H., B.B., V.D., P. Maeder, G.S.), Neuroradiology Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
AJNR Am J Neuroradiol. 2022 Dec;43(12):1743-1748. doi: 10.3174/ajnr.A7705. Epub 2022 Nov 24.
Procedural complications occur in 4%-29% of endovascular treatments in acute ischemic stroke. However, little is known about their predictors and clinical impact in the real world. We aimed to investigate the frequency and clinical impact of procedural complications of endovascular treatment and identify associated risk factors.
From 2015-2019, we retrospectively reviewed all patients with acute ischemic stroke receiving endovascular treatment within 24 hours included in the Acute STroke Registry and Analysis of Lausanne. We identified patients having an endovascular treatment procedural complication (local access complication, arterial perforation, dissection or vasospasm, and embolization in a previously nonischemic territory) and performed logistic regression analyses to identify associated predictors. We also correlated procedural complications with long-term clinical outcome.
Of the 684 consecutive patients receiving endovascular treatment, 113 (16.5%) had at least 1 procedural complication. The most powerful predictors were groin puncture off-hours (OR = 2.24), treatment of 2 arterial sites (OR = 2.71), and active smoking (OR = 1.93). Patients with a complication had a significantly less favorable short-term clinical outcome (Δ-NIHSS score of -2.2 versus -4.33, -value adjusted < .001), but a similar long-term clinical outcome (mRS at 3 months = 3 versus 2, -value adjusted = .272).
Procedural complications are quite common in endovascular treatment and lead to a less favorable short-term but similar long-term outcome. Their association with treatment off-hours and at 2 arterial sites requires particular attention in these situations to optimize the overall benefit of endovascular treatment.
在急性缺血性卒中的血管内治疗中，手术并发症的发生率为4% - 29%。然而，对于其预测因素及在现实世界中的临床影响知之甚少。我们旨在研究血管内治疗手术并发症的发生率及临床影响，并确定相关危险因素。
2015年至2019年，我们回顾性分析了洛桑急性卒中登记与分析中所有在24小时内接受血管内治疗的急性缺血性卒中患者。我们确定了发生血管内治疗手术并发症（局部穿刺并发症、动脉穿孔、夹层或血管痉挛，以及在先前无缺血区域的栓塞）的患者，并进行逻辑回归分析以确定相关预测因素。我们还将手术并发症与长期临床结局进行关联分析。
在连续接受血管内治疗的684例患者中，113例（16.5%）至少发生了1种手术并发症。最有力的预测因素是腹股沟穿刺非工作时间（比值比 = 2.24）、两个动脉部位的治疗（比值比 = 2.71）和当前吸烟（比值比 = 1.93）。发生并发症的患者短期临床结局明显较差（美国国立卫生研究院卒中量表评分变化为 -2.2 对比 -4.33，校正P值 <.001），但长期临床结局相似（3个月时改良Rankin量表评分 = 3对比2，校正P值 =.272）。
手术并发症在血管内治疗中相当常见，会导致短期结局较差但长期结局相似。在这些情况下，它们与非工作时间治疗及两个动脉部位治疗的关联需要特别关注，以优化血管内治疗的总体获益。
