Abstract
PurposeKnowledge about the localization and outcome of iatrogenic dissection (ID) during endovascular treatment of acute ischemic stroke (AIS) is limited. We aimed to determine the frequency, clinical aspects and morphology of ID in endovascular AIS treatment and to identify predictors of this complication.MethodsDigital subtraction angiography (DSA) of ID carried out during endovascular treatment between January 2000 and March 2012 have been re-evaluated. The ID localization and morphology were analyzed and related to the interventional techniques. Baseline clinical and radiological findings, treatment modality and outcome were compared with patients without ID.ResultsOut of 866 patients 18 (2%) suffered an ID (44% female, median age 64 years). Localization was extracranial in 15 (83%, 14 internal carotid artery and 1 vertebral artery) and intracranial in 3 (17%; 1 vertebrobasilar dissection and 2 in the anterior circulation). Of the IDs 5 (28%) resulted in a high-degree, 3 (17%) in a moderate, 5 (28%) in a mild and 5 (28%) in no stenosis and 8 IDs were stented in the acute phase. At 3 months 7 (42%) patients had a favorable outcome (modified Rankin score mRS ≤ 2) and 6 (33%) patients had died. Patients with ID had a different stroke etiology (p = 0.041), were more likely to be smokers (44% versus 19%, p = 0.015) and were more likely to be treated with mechanical thrombectomy (100% versus 60%, p < 0.001). Although two ID patients had relevant complications, the outcome did not differ between the groups.ConclusionThe occurrence of ID is a rare complication of endovascular AIS treatment associated with smoking and mechanical thrombectomy.
Highlights
Acute arterial ischemic stroke (AIS) is one of the leading causes of mortality and morbidity worldwide [1, 2]
5 randomized controlled trials have shown that endovascular clot retrieval in addition to best medical treatment with or without intravenous recombinant tissue plasminogen activator improves outcome in patients with stroke occurring in the anterior circulation with proximal vessel occlusion [5,6,7,8,9]; despite minimally invasive device systems, endovascular procedures still carry a risk of iatrogenic complications, potentially worsening the outcome
We reviewed clinical and imaging data on all AIS patients aged ≥16 years who underwent endovascular AIS treatment between January 2000 and March 2012
Summary
Acute arterial ischemic stroke (AIS) is one of the leading causes of mortality and morbidity worldwide [1, 2]. 5 randomized controlled trials have shown that endovascular clot retrieval in addition to best medical treatment with or without intravenous recombinant tissue plasminogen activator (rtPA) improves outcome in patients with stroke occurring in the anterior circulation with proximal vessel occlusion [5,6,7,8,9]; despite minimally invasive device systems, endovascular procedures still carry a risk of iatrogenic complications, poten-. A few studies have reported complication rates in endovascular AIS treatment (ranging from 1.7% to 3.9%), but clinical characteristics, risk factors, outcomes and morphological descriptions are lacking [5, 9, 16, 17]. We aimed to assess the localization and morphology of ID, the clinical characteristics and risk factors for ID and outcomes in patients suffering from ID
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