Complications of mechanical thrombectomy for acute ischemic stroke—a retrospective single-center study of 176 consecutive cases

Abstract

Introduction

There is only very limited data about complications in mechanical thrombectomy for acute ischemic stroke. The purpose of this study was to evaluate the frequency and the clinical relevance of procedure-related complications in mechanical thrombectomy.

Methods

We conducted a retrospective analysis of 176 consecutive acute ischemic stroke cases that were treated with mechanical thrombectomy. Primary outcome measures included the following: symptomatic intracranial hemorrhage (sICH), vessel dissection, emboli to new vascular territories, vasospasm, and stent dislocation/occlusion whenever appropriate. Secondary outcome measures included mTICI score, time from symptom onset to revascularization, and time from groin puncture to revascularization as well as the early clinical outcome at discharge.

Results

Complications occurred in 20/176 patients (11 %) comprising 23 adverse events at the following rates: sICH 8/176 (5 %), emboli to new vascular territories 4/176 (2 %); vessel dissection 3/176 (2 %); vasospasm of the access vessel 5/176 (3 %); stent dislocation in 1/42 (2 %); and stent occlusion in 2/42 (5 %). Two out of 20 (10 %) suffered from two or more procedure-related complications. There was a statistically significant correlation of complications with time from groin puncture to revascularization, unfavorable revascularization results, and unfavorable clinical outcome.

Conclusion

Overall, the frequency of procedure-related complications lies within acceptable limits for an emergency procedure. The endovascular treatment does not seem to add significantly to the stroke patients’ risk of sICH but implies an innate risk of stroke in an initially uninvolved territory. Furthermore, a prolonged endovascular procedure beyond an hour is correlated with higher complication rates, which underlines the importance of a swift and complete revascularization.

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Abbreviations

ENT:

Embolization(s) to new territory

i.v.:

Intravenous

IVT:

Intravenous thrombolysis

MT:

Mechanical thrombectomy

NIHSS:

National Institute of Health Stroke Scale

mTICI:

Modified thrombolysis in cerebral infarction

mRS:

Modified Rankin Scale

n.s.:

Not stated

ns:

Not significant

SAH:

Subarachnoid hemorrhage

sICH:

Symptomatic intracranial hemorrhage

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We declare that we have no conflict of interest.

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Correspondence to Daniel Behme.

Additional information

Anastasios Mpotsaris and Werner Weber contributed equally to this work.

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Behme, D., Gondecki, L., Fiethen, S. et al. Complications of mechanical thrombectomy for acute ischemic stroke—a retrospective single-center study of 176 consecutive cases. Neuroradiology 56, 467–476 (2014). https://doi.org/10.1007/s00234-014-1352-0

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Keywords

  • Complications
  • Thrombectomy
  • Acute ischemic stroke
  • Stenting