Schulze-Zachau Victor, Rommers Nikki, Ntoulias Nikolaos, Brehm Alex, Krug Nadja, Tsogkas Ioannis, Mutke Matthias, Rusche Thilo, Cervo Amedeo, Rollo Claudia, Möhlenbruch Markus, Jesser Jessica, Kreiser Kornelia, Althaus Katharina, Requena Manuel, Rodrigo-Gisbert Marc, Dobrocky Tomas, Serrallach Bettina L, Nolte Christian H, Riegler Christoph, Nawabi Jawed, Maslias Errikos, Michel Patrik, Saliou Guillaume, Manning Nathan, McQuinn Alexander, Taylor Alon, Maurer Christoph J, Berlis Ansgar, Kaiser Daniel Po, Cuberi Ani, Moreu Manuel, López-Frías Alfonso, Pérez-García Carlos, Rautio Riitta, Pauli Ylikotila, Limbucci Nicola, Renieri Leonardo, Fragata Isabel, Rodriguez-Ares Tania, Kirschke Jan S, Schwarting Julian, Al Kasab Sami, Spiotta Alejandro M, Abu Qdais Ahmad, Dmytriw Adam A, Regenhardt Robert W, Patel Aman B, Pereira Vitor Mendes, Cancelliere Nicole M, Schmeel Carsten, Dorn Franziska, Sauer Malte, Karwacki Grzegorz M, Khalife Jane, Thomas Ajith J, Shaikh Hamza A, Commodaro Christian, Pileggi Marco, Schwab Roland, Bellante Flavio, Dusart Anne, Hofmeister Jeremy, Machi Paolo, Samaniego Edgar A, Ojeda Diego J, Starke Robert M, Abdelsalam Ahmed, van den Bergh Frans, De Raedt Sylvie, Bester Maxim, Flottmann Fabian, Weiss Daniel, Kaschner Marius, Kan Peter T, Edhayan Gautam, Levitt Michael R, Raub Spencer L, Katan Mira, Fischer Urs, Psychogios Marios-Nikos
Department of Diagnostic & Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland.
Clinical Research Department, University Basel, Basel, Switzerland.
Eur Stroke J. 2025 Mar;10(1):63-73. doi: 10.1177/23969873241272542. Epub 2024 Aug 22.
Thrombectomy complications remain poorly explored. This study aims to characterize periprocedural intracranial vessel perforation including the effect of thrombolysis on patient outcomes.
In this multicenter retrospective cohort study, consecutive patients with vessel perforation during thrombectomy between January 2015 and April 2023 were included. Vessel perforation was defined as active extravasation on digital subtraction angiography. The primary outcome was modified Rankin Scale (mRS) at 90 days. Factors associated with the primary outcome were assessed using proportional odds models.
459 patients with vessel perforation were included (mean age 72.5 ± 13.6 years, 59% female, 41% received thrombolysis). Mortality at 90 days was 51.9% and 16.3% of patients reached mRS 0-2 at 90 days. Thrombolysis was not associated with worse outcome at 90 days. Perforation of a large vessel (LV) as opposed to medium/distal vessel perforation was independently associated with worse outcome at 90 days (aOR 1.709, = 0.04) and LV perforation was associated with poorer survival probability (HR 1.389, = 0.021). Patients with active bleeding >20 min had worse survival probability, too (HR 1.797, = 0.009). Thrombolysis was not associated with longer bleeding duration. Bleeding cessation was achieved faster by permanent vessel occlusion compared to temporary measures (median difference: 4 min, < 0.001).
Vessel perforation during thrombectomy is a severe and frequently fatal complication. This study does not suggest that thrombolysis significantly attributes to worse prognosis. Prompt cessation of active bleeding within 20 min is critical, emphasizing the need for interventionalists to be trained in complication management.
血栓切除术的并发症仍未得到充分研究。本研究旨在描述围手术期颅内血管穿孔的特征，包括溶栓对患者预后的影响。
在这项多中心回顾性队列研究中，纳入了2015年1月至2023年4月期间血栓切除术中发生血管穿孔的连续患者。血管穿孔定义为数字减影血管造影上的活动性血管外渗。主要结局是90天时的改良Rankin量表（mRS）。使用比例优势模型评估与主要结局相关的因素。
纳入了459例发生血管穿孔的患者（平均年龄72.5±13.6岁，59%为女性，41%接受了溶栓治疗）。90天时的死亡率为51.9%，16.3%的患者在90天时达到mRS 0 - 2。溶栓与90天时更差的结局无关。与中/远端血管穿孔相比，大血管（LV）穿孔与90天时更差的结局独立相关（调整后比值比1.709，P = 0.04），且LV穿孔与较差的生存概率相关（风险比1.389，P = 0.021）。活动性出血>20分钟的患者生存概率也较差（风险比1.797，P = 0.009）。溶栓与更长的出血持续时间无关。与临时措施相比，永久性血管闭塞能更快实现出血停止（中位数差异：4分钟，P < 0.001）。
血栓切除术中的血管穿孔是一种严重且常致命的并发症。本研究并未表明溶栓会显著导致更差的预后。在20分钟内迅速停止活动性出血至关重要，这强调了介入医生需要接受并发症管理方面的培训。
