Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Neuroradiology. 2024 Feb;66(2):237-247. doi: 10.1007/s00234-023-03246-2. Epub 2023 Nov 27.
Endovascular treatment (EVT) of acute ischemic stroke can be complicated by vessel perforation. We studied the incidence and determinants of vessel perforations. In addition, we studied the association of vessel perforations with functional outcome, and the association between location of perforation on digital subtraction angiography (DSA) and functional outcome, using a large EVT registry.
We included all patients in the MR CLEAN Registry who underwent EVT. We used DSA to determine whether EVT was complicated by a vessel perforation. We analyzed the association with baseline clinical and interventional parameters using logistic regression models. Functional outcome was measured using the modified Rankin Scale at 90 days. The association between vessel perforation and angiographic imaging features and functional outcome was studied using ordinal logistic regression models adjusted for prognostic parameters. These associations were expressed as adjusted common odds ratios (acOR).
Vessel perforation occurred in 74 (2.6%) of 2794 patients who underwent EVT. Female sex (aOR 2.0 (95% CI 1.2-3.2)) and distal occlusion locations (aOR 2.2 (95% CI 1.3-3.5)) were associated with increased risk of vessel perforation. Functional outcome was worse in patients with vessel perforation (acOR 0.38 (95% CI 0.23-0.63)) compared to patients without a vessel perforation. No significant association was found between location of perforation and functional outcome.
The incidence of vessel perforation during EVT in this cohort was low, but has severe clinical consequences. Female patients and patients treated at distal occlusion locations are at higher risk.
急性缺血性脑卒中的血管内治疗（EVT）可能会导致血管穿孔。本研究旨在探讨血管穿孔的发生率及相关影响因素。此外，本研究还通过一个大型 EVT 登记研究，探讨了血管穿孔与功能结局的关系，以及血管穿孔在数字减影血管造影（DSA）上的位置与功能结局之间的关系。
本研究纳入了 MR CLEAN 登记研究中所有接受 EVT 治疗的患者。我们使用 DSA 确定 EVT 是否并发血管穿孔。我们使用逻辑回归模型分析了与基线临床和介入参数之间的关系。采用改良 Rankin 量表（mRS）在 90 天评估功能结局。使用有序逻辑回归模型调整预后参数，分析血管穿孔与血管造影成像特征和功能结局之间的关系。这些关联用调整后的常见比值比（acOR）表示。
2794 例行 EVT 的患者中，74 例（2.6%）发生血管穿孔。女性（aOR 2.0（95% CI 1.2-3.2））和远端闭塞部位（aOR 2.2（95% CI 1.3-3.5））与血管穿孔风险增加相关。与无血管穿孔患者相比，血管穿孔患者的功能结局更差（acOR 0.38（95% CI 0.23-0.63））。血管穿孔的位置与功能结局之间无显著相关性。
在该队列中，EVT 期间血管穿孔的发生率较低，但具有严重的临床后果。女性患者和治疗于远端闭塞部位的患者风险更高。
