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Clinical consequence of vessel perforations during endovascular treatment of acute ischemic stroke

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusion

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.

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Data availability

The datasets created in this study can be obtained from the corresponding author upon reasonable request. Additionally, the datasets analyzed in this study can be requested from the MR CLEAN trial office at mrclean@erasmusmc.nl.

Abbreviations

A1-A2-A3:

Segment of anterior cerebral artery

DSA:

Digital subtraction angiography

EVT:

Endovascular thrombectomy

eTICI:

Extended Treatment In Cerebral Ischemia score

ICA:

Internal carotid artery

IVT:

Intravenous thrombolysis

M1-M2-M3:

M1-M2-M3 segment of middle cerebral artery

mRS:

Modified Rankin Scale

NIHSS:

National Institutes of Health Stroke Scale

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Acknowledgements

We thank the MR CLEAN Registry investigators for their contribution. A list of all investigators is given in the supplement material.

Funding

The MR CLEAN Registry was partly funded by TWIN Foundation, Erasmus MC University Medical Center, Maastricht University Medical Center, and Amsterdam UMC. Erasmus MC received funds from Stryker® by DD, AvdL, and Bracco Imaging® by DD. Amsterdam UMC received funds from Stryker® for consultations by CM, YR, and OB. MUMC received funds from Stryker® and Codman® for consultations by WZ. The current work on clinical consequence of vessel perforations was supported by Health-Holland (TKI Life Sciences and Health) through the Q-Maestro project under Grant EMCLSH19006 and Philips Healthcare (Best, The Netherlands).

Author information

Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands

    P. Matthijs van der Sluijs, R. Su, S. A. P. Cornelissen, P. J. van Doormaal, A. van der Lugt & T. van Walsum

  2. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

    A. C. G. M. van Es

  3. Department of Radiology, Haaglanden Medical Center, the Hague, The Netherlands

    G. Lycklama a Nijeholt

  4. Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands

    B. Roozenbeek

  5. Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands

    J. Hofmeijer

  6. Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands

    J. Hofmeijer

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  1. P. Matthijs van der Sluijs
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Consortia

On Behalf Of the MR CLEAN Registry investigators

  • Diederik W. J. Dippel
  • , Charles B. L. M. Majoie
  • , Yvo B. W. E. M. Roos
  • , Robert J. van Oostenbrugge
  • , Wim H. van Zwam
  • , Jelis Boiten
  • , Jan Albert Vos
  • , Ivo G. H. Jansen
  • , Maxim J. H. L. Mulder
  • , Robert-Jan B. Goldhoorn
  • , Kars C. J. Compagne
  • , Manon Kappelhof
  • , Josje Brouwer
  • , Sanne J. den Hartog
  • , Wouter H. Hinsenveld
  • , Bart J. Emmer
  • , Jonathan M. Coutinho
  • , Wouter J. Schonewille
  • , Marieke J. H. Wermer
  • , Marianne A. A. van Walderveen
  • , Julie Staals
  • , Jasper M. Martens
  • , Sebastiaan F. de Bruijn
  • , Lukas C. van Dijk
  • , H. Bart van der Worp
  • , Rob H. Lo
  • , Ewoud J. van Dijk
  • , Hieronymus D. Boogaarts
  • , J. de Vries
  • , Paul L. M. de Kort
  • , Julia van Tuijl
  • , Jo P. Peluso
  • , Puck Fransen
  • , Jan S. P. van den Berg
  • , Boudewijn A. A. M. van Hasselt
  • , Leo A. M. Aerden
  • , René J. Dallinga
  • , Maarten Uyttenboogaart
  • , Omid Eschgi
  • , Reinoud P. H. Bokkers
  • , Tobien H. C. M. L. Schreuder
  • , Roel J. J. Heijboer
  • , Koos Keizer
  • , Lonneke S. F. Yo
  • , Heleen M. den Hertog
  • , Tomas Bulut
  • , Paul J. A. M. Brouwers
  • , Marieke E. S. Sprengers
  • , Sjoerd F. M. Jenniskens
  • , René van den Berg
  • , Albert J. Yoo
  • , Ludo F. M. Beenen
  • , Alida A. Postma
  • , Stefan D. Roosendaal
  • , Bas F. W. van der Kallen
  • , Ido R. van den Wijngaard
  • , Joost Bot
  • , Anton Meijer
  • , Elyas Ghariq
  • , Marc P. van Proosdij
  • , G. Menno Krietemeijer
  • , Wouter Dinkelaar
  • , Auke P. A. Appelman
  • , Bas Hammer
  • , Sjoert Pegge
  • , Anouk van der Hoorn
  • , Saman Vinke
  • , H. Zwenneke Flach
  • , Hester F. Lingsma
  • , Naziha el Ghannouti
  • , Martin Sterrenberg
  • , Wilma Pellikaan
  • , Rita Sprengers
  • , Marjan Elfrink
  • , Michelle Simons
  • , Marjolein Vossers
  • , Joke de Meris
  • , Tamara Vermeulen
  • , Annet Geerlings
  • , Gina van Vemde
  • , Tiny Simons
  • , Gert Messchendorp
  • , Nynke Nicolaij
  • , Hester Bongenaar
  • , Karin Bodde
  • , Sandra Kleijn
  • , Jasmijn Lodico
  • , Hanneke Droste
  • , Maureen Wollaert
  • , Sabrina Verheesen
  • , D. Jeurrissen
  • , Erna Bos
  • , Yvonne Drabbe
  • , Michelle Sandiman
  • , Nicoline Aaldering
  • , Berber Zweedijk
  • , Jocova Vervoort
  • , Eva Ponjee
  • , Sharon Romviel
  • , Karin Kanselaar
  • , Denn Barning
  • , Esmee Venema
  • , Vicky Ralph R. ChalosGeuskens
  • , Tim van Straaten
  • , Saliha Ergezen
  • , Roger R. M. Harmsma
  • , Daan Anouk Muijresde Jong
  • , Olvert A. Berkhemer
  • , Anna M. M. J. BoersHuguet
  • , P. F. C. Groot
  • , Marieke A. Mens
  • , Katinka R. van Kranendonk
  • , Kilian M. Treurniet
  • , Manon L. Tolhuisen
  • , Heitor Alves
  • , Annick J. Eleonora L. F. WeteringsKirkels
  • , Eva J. H. F. Voogd
  • , Lieve M. Schupp
  • , Sabine L. Collette
  • , Adrien E. D. Groot
  • , Natalie E. LeCouffe
  • , Praneeta R. Konduri
  • , Haryadi Prasetya
  • , Nerea Arrarte-Terreros
  •  & Lucas A. Ramos

Corresponding author

Correspondence to P. Matthijs van der Sluijs.

Ethics declarations

Ethics approval

The central medical ethics committee of the Erasmus MC University Medical Center, Rotterdam, the Netherlands, evaluated the study protocol and granted permission to carry out the study as a registry (MEC-2014–235).

Consent to participate

All patients or their legal representatives provided written informed consent.

Conflict of interest

P. Matthijs van der Sluijs — no conflict of interest.

R. Su — no conflict of interest.

S.A.P. Cornelissen — no conflict of interest.

A.C.G.M. van Es — no conflict of interest.

G. Lycklama a Nijeholt — no conflict of interest.

B. Roozenbeek — no conflict of interest.

P.J. van Doormaal — no conflict of interest.

J. Hofmeijer — no conflict of interest.

A. van der Lugt — no conflict of interest.

T. van Walsum — no conflict of interest.

Standards of reporting

This study is reported in accordance with the STROBE guidelines (Strengthening the Reporting of Observational Studies in Epidemiology).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Full list of contributors is listed in the supplemental appendix.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 325 KB)

Appendix

Appendix

MR CLEAN Registry Investigators — group authors

Executive committee

Diederik W.J. Dippel1; Aad van der Lugt2; Charles B.L.M. Majoie3; Yvo B.W.E.M. Roos4; Robert J. van Oostenbrugge5,41; Wim H. van Zwam6,41; Jelis Boiten14; Jan Albert Vos8

Study coordinators

Ivo G.H. Jansen3; Maxim J.H.L. Mulder1,2; Robert- Jan B. Goldhoorn5,6,41; Kars C.J. Compagne2; Manon Kappelhof3; Josje Brouwer4; Sanne J. den Hartog1,2,40; Wouter H. Hinsenveld5,6

Local principal investigators

Diederik W.J. Dippel1; Bob Roozenbeek1; Aad van der Lugt2; Adriaan C.G.M. van Es2; Charles B.L.M. Majoie3; Yvo B.W.E.M. Roos4; Bart J. Emmer3; Jonathan M. Coutinho4; Wouter J. Schonewille7; Jan Albert Vos8; Marieke J.H. Wermer9; Marianne A.A. van Walderveen10; Julie Staals5,41; Robert J. van Oostenbrugge5,41; Wim H. van Zwam6,41; Jeannette Hofmeijer11; Jasper M. Martens12; Geert J. Lycklama à Nijeholt13; Jelis Boiten14; Sebastiaan F. de Bruijn15; Lukas C. van Dijk16; H. Bart van der Worp17; Rob H. Lo18; Ewoud J. van Dijk19; Hieronymus D. Boogaarts20; J. de Vries22; Paul L.M. de Kort21; Julia van Tuijl21; Jo P. Peluso26; Puck Fransen22; Jan S.P. van den Berg22; Boudewijn A.A.M. van Hasselt23; Leo A.M. Aerden24; René J. Dallinga25; Maarten Uyttenboogaart28; Omid Eschgi29; Reinoud P.H. Bokkers29; Tobien H.C.M.L. Schreuder30; Roel J.J. Heijboer31; Koos Keizer32; Lonneke S.F. Yo33; Heleen M. den Hertog22; Tomas Bulut35; Paul J.A.M. Brouwers34

Imaging assessment committee

Charles B.L.M. Majoie3 (chair); Wim H. van Zwam6,41; Aad van der Lugt2; Geert J. Lycklama à Nijeholt13; Marianne A.A. van Walderveen10; Marieke E.S. Sprengers3; Sjoerd F.M. Jenniskens27; René van den Berg3; Albert J. Yoo38; Ludo F.M. Beenen3; Alida A. Postma6,42; Stefan D. Roosendaal3; Bas F.W. van der Kallen13; Ido R. van den Wijngaard13; Adriaan C.G.M. van Es2; Bart J. Emmer,3; Jasper M. Martens12; Lonneke S.F. Yo33; Jan Albert Vos8; Joost Bot36; Pieter-Jan van Doormaal2; Anton Meijer27; Elyas Ghariq13; Reinoud P.H. Bokkers29; Marc P. van Proosdij37; G. Menno Krietemeijer33; Jo P. Peluso26; Hieronymus D. Boogaarts20; Rob Lo18; Wouter Dinkelaar2; Auke P.A. Appelman29; Bas Hammer16; Sjoert Pegge27; Anouk van der Hoorn29; Saman Vinke20

Writing committee

Diederik W.J. Dippel1 (chair); Aad van der Lugt2; Charles B.L.M. Majoie3; Yvo B.W.E.M. Roos4; Robert J. van Oostenbrugge5,41; Wim H. van Zwam6,41; Geert J. Lycklama à Nijeholt13; Jelis Boiten14; Jan Albert Vos8; Wouter J. Schonewille7; Jeannette Hofmeijer11; Jasper M. Martens12; H. Bart van der Worp17; Rob H. Lo18

Adverse event committee

Robert J. van Oostenbrugge5,41 (chair); Jeannette Hofmeijer11; H. Zwenneke Flach23

Trial methodologist

Hester F. Lingsma40

Research nurses/local trial coordinators

Naziha el Ghannouti1; Martin Sterrenberg1; Wilma Pellikaan7; Rita Sprengers4; Marjan Elfrink11; Michelle Simons11; Marjolein Vossers12; Joke de Meris14; Tamara Vermeulen14; Annet Geerlings19; Gina van Vemde22; Tiny Simons30; Gert Messchendorp28; Nynke Nicolaij28; Hester Bongenaar32; Karin Bodde24; Sandra Kleijn34; Jasmijn Lodico34; Hanneke Droste34; Maureen Wollaert5; Sabrina Verheesen5; D. Jeurrissen5; Erna Bos9; Yvonne Drabbe15; Michelle Sandiman15; Nicoline Aaldering11; Berber Zweedijk17; Jocova Vervoort21; Eva Ponjee22; Sharon Romviel19; Karin Kanselaar19; Denn Barning10

PhD/Medical students

Esmee Venema40; Vicky Chalos1,40; Ralph R. Geuskens3; Tim van Straaten19; Saliha Ergezen1; Roger R.M. Harmsma1; Daan Muijres1; Anouk de Jong1; Olvert A. Berkhemer1,3,6; Anna M.M. Boers3,39; J. Huguet3; P.F.C. Groot3; Marieke A. Mens3; Katinka R. van Kranendonk3; Kilian M. Treurniet3; Manon L. Tolhuisen3,39; Heitor Alves3; Annick J. Weterings3; Eleonora L.F. Kirkels3; Eva J.H.F. Voogd11; Lieve M. Schupp3; Sabine L. Collette28,29; Adrien E.D. Groot4; Natalie E. LeCouffe4; Praneeta R. Konduri39; Haryadi Prasetya39; Nerea Arrarte-Terreros39; Lucas A. Ramos39

List of affiliations

Department of Neurology1, Radiology2, Public Health40, Erasmus MC University Medical Center;

Department of Radiology and Nuclear Medicine3, Neurology4, Biomedical Engineering & Physics39, Amsterdam UMC, location University of Amsterdam;

Department of Neurology5, Radiology & Nuclear Medicine6, Maastricht University Medical Center; School for Cardiovascular Diseases Maastricht (CARIM)41; and MHeNs School for Mental Health and Neuroscience, Maastricht, the Netherlands42;

Department of Neurology7, Radiology8, Sint Antonius Hospital, Nieuwegein;

Department of Neurology9, Radiology10, Leiden University Medical Center;

Department of Neurology11, Radiology12, Rijnstate Hospital, Arnhem;

Department of Radiology13, Neurology14, Haaglanden MC, the Hague;

Department of Neurology15, Radiology16, HAGA Hospital, the Hague;

Department of Neurology17, Radiology18, University Medical Center Utrecht;

Department of Neurology19, Neurosurgery20, Radiology27, Radboud University Medical Center, Nijmegen;

Department of Neurology21, Radiology26, Elisabeth-TweeSteden ziekenhuis, Tilburg;

Department of Neurology22, Radiology23, Isala Klinieken, Zwolle;

Department of Neurology24, Radiology25, Reinier de Graaf Gasthuis, Delft;

Department of Neurology28, Radiology29, University Medical Center Groningen;

Department of Neurology30, Radiology31, Atrium Medical Center, Heerlen;

Department of Neurology32, Radiology33, Catharina Hospital, Eindhoven;

Department of Neurology34, Radiology35, Medisch Spectrum Twente, Enschede;

Department of Radiology36, Amsterdam UMC, Vrije Universiteit van Amsterdam, Amsterdam;

Department of Radiology37, Noordwest Ziekenhuisgroep, Alkmaar;

Department of Radiology38, Texas Stroke Institute, TX, USA.

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van der Sluijs, P., Su, R., Cornelissen, S.A. et al. Clinical consequence of vessel perforations during endovascular treatment of acute ischemic stroke. Neuroradiology 66, 237–247 (2024). https://doi.org/10.1007/s00234-023-03246-2

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