Giancarlo Salsano1, Giovanni Pracucci2, Nicola Mavilio1, Valentina Saia3, Monica Bandettini di Poggio4, Laura Malfatto1, Fabrizio Sallustio5, Andrea Wlderk5, Nicola Limbucci6, Patrizia Nencini6, Stefano Vallone7, Andrea Zini8, Guido Bigliardi7, Mariano Velo9, Isabella Francalanza9, Paola Gennari10, Rossana Tassi10, Mauro Bergui11, Paolo Cerrato11, Giuseppe Carità12, Cristiano Azzini12, Roberto Gasparotti13, Mauro Magoni13, Salvatore Isceri8, Christian Commodaro14, Francesco Cordici14, Roberto Menozzi15, Lilia Latte15, Mirco Cosottini16, Michelangelo Mancuso16, Alessio Comai17, Enrica Franchini17, Andrea Alexandre18, Giacomo Della Marca18, Edoardo Puglielli19, Alfonsina Casalena19, Francesco Causin20, Claudio Baracchini20, Luca Di Maggio21, Andrea Naldi21, Andrea Grazioli22, Stefano Forlivesi22, Luigi Chiumarulo23, Marco Petruzzellis23, Giuseppina Sanfilippo24, Gianpaolo Toscano24, Nicola Cavasin25, Critelli Adriana25, Maria Porzia Ganimede26, Maria Pia Prontera26, Giorgianni Andrea27, Marco Mauri27, William Auteri28, Alfredo Petrone28, Carlo Cirelli29, Anne Falcou29, Simona Corraine30, Valeria Piras30, Giuseppe Ganci3, Tiziana Tassinari3, Nunzio Paolo Nuzzi31, Manuel Corato31, Simona Sacco32, Guido Squassina13, Paolo Invernizzi13, Ivan Gallesio33, Delfina Ferrandi33, Giovanni Dui34, Gianluca Deiana34, Pietro Amistà35, Monia Russo35, Francesco Pintus36, Antonio Baule36, Giuseppe Craparo37, Marina Mannino37, Lucio Castellan1, Danilo Toni38, Salvatore Mangiafico6. 1. IRCCS San Martino Policlinic Hospital, Neuroradiology and Neurology, Genoa, Italy. 2. Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy. 3. Neuroradiology Unit and Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy. 4. IRCCS San Martino Policlinic Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genoa, Italy. 5. Imaging and Interventional Radiology and Stroke Unit, Policlinico Tor Vergata, Roma, Italy. 6. Interventional Neurovascular Unit and Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy. 7. Neuroradiology and Neurology, Ospedale Civile S. Agostino-Estense, University Hospital, Modena, Italy. 8. IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center and Neuroradiology, Maggiore Hospital, Bologna, Italy. 9. Neuroradiology and Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Policlinico G. Martino Messina, Italy. 10. Neuroradiology and Neurology, 161157AOU Senese, Siena, Italy. 11. Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy. 12. Neuroradiology and Neurology, Arcispedale S. Anna-University Hospital, Ferrara, Italy. 13. Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy. 14. Department of Neuroradiology, Neurology and Stroke Unit, Cesena-Forlì, AUSL Romagna Azienda Ospedaliera, Cesena, Italy. 15. Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy. 16. Department of Translational Research and New Technologies in Medicine and Surgery, 9310University of Pisa, Pisa, Italy. 17. Radiology Unit and Stroke Unit, Ospedale Centrale, Bolzano, Italy. 18. Institute of Neuroradiology and Neurology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy. 19. Ospedale Civile Mazzini, Teramo, Italy. 20. Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Padua, Italy. 21. Neuroradiology and Neurology, 18698Ospedale San Giovanni Bosco, Torino, Italy. 22. UOC Neuroradiologia, DAI Patologia e Diagnostica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 23. Interventional Neuroradiology Unit and Stroke Unit, Policlinico, Bari, Italy. 24. Diagnostic and Interventional Neuroradiology Unit and Stroke Unit, IRCCS Mondino Foundation San Matteo Hospital, Pavia, Italy. 25. Neuroradiology Unit and Neurology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy. 26. Interventional Radiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy. 27. Neuroradiology Unit and Stroke Unit, Ospedale Universitario Circolo, ASST Sette Laghi, Varese, Italy. 28. Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy. 29. Department of Human Neurosciences, Interventional Neuroradiology and Neurology, Università degli Studi di Roma Sapienza, Roma, Lazio, Italy. 30. Neuroscience Department, Azienda Ospedaliera G. Brotzu, Cagliari, Sardinia, Italy. 31. IRCCS Humanitas Clinical and Research Center, Rozzano, Milano, Italy. 32. Department of Clinical Scieces and Biotechnology, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy. 33. Department of Radiology and Neuroradiological Unit, Department of Neurology, Azienda ospedaliera "SS Antonio e Biagio e C. Arrigo," Alessandria, Italy. 34. Radiology and Interventional Radiology Unit and Neurology Unit, 97998Ospedale San Francesco, Nuoro, Italy. 35. Department of Neuroradiology and Neurology, Hospital of Rovigo, Rovigo, Italy. 36. Unit of Neuroradiology and Stroke Unit, Santissima Annunziata Hospital, Sassari, Italy. 37. Department of Neuroradiology and Neurology, AOOR Villa Sofia-V. Cervello, Palermo, Italy. 38. Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
Abstract
BACKGROUND: There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes. AIMS: We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications. METHODS: From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected. RESULTS: The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21-2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13-8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66-12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31-0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97-0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19-0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6-0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02-1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02-1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25-2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26-3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08-2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55-0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up. CONCLUSIONS: Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits.
BACKGROUND: There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes. AIMS: We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications. METHODS: From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected. RESULTS: The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21-2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13-8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66-12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31-0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97-0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19-0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6-0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02-1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02-1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25-2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26-3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08-2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55-0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up. CONCLUSIONS: Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits.
Authors: Andrea Maria Alexandre; Iacopo Valente; Alessandro Pedicelli; Angelo Maria Pezzullo; Francesca Colò; Luca Scarcia; Andrea Romi; Mariangela Piano; Antonio Macera; Joseph Domenico Gabrieli; Giacomo Cester; Antonio Armando Caragliano; Sergio Lucio Vinci; Maria Ruggiero; Christian Commodaro; Andrea Saletti; Guido Andrea Lazzarotti; Mirco Cosottini; Valerio Da Ros; Luigi Bellini; Emilio Lozupone; Adriana Paladini; Valerio Brunetti; Roberta Morosetti; Giovanni Frisullo; Paolo Calabresi; Giacomo Della Marca; Aldobrando Broccolini Journal: Neurol Sci Date: 2021-11-29 Impact factor: 3.830
Authors: Ana López-de-Andrés; Rodrigo Jimenez-Garcia; Valentin Hernández-Barrera; Isabel Jiménez-Trujillo; José J Zamorano-León; David Carabantes-Alarcon; Marta Lopez-Herranz; José M de Miguel-Yanes; Javier de Miguel-Diez Journal: Int J Environ Res Public Health Date: 2021-04-01 Impact factor: 3.390
Authors: Andrea M Alexandre; Iacopo Valente; Arturo Consoli; Pietro Trombatore; Luca Scarcia; Mariangela Piano; Nicola Limbucci; Joseph Domenico Gabrieli; Riccardo Russo; Antonio Armando Caragliano; Maria Ruggiero; Andrea Saletti; Guido Andrea Lazzarotti; Marco Pileggi; Mirco Cosottini; Fabio Pilato; Artur Slomka; Francesca Colò; Francesca Giubbolini; Giovanni Frisullo; Giacomo Della Marca; Aldobrando Broccolini; Alessandro Pedicelli Journal: Life (Basel) Date: 2021-12-17