Successful Reperfusion is Associated with Favorable Functional Outcome despite Vessel Perforation during Thrombectomy: A Case Series and Systematic Review

Abstract

Background: Arterial perforation is a potentially serious complication during endovascular thrombectomy.

Purpose: Our aim was to describe interventional approaches after arterial perforation during endovascular thrombectomy and to determine whether reperfusion remains associated with favorable outcome despite this complication.

Data sources: Data from consecutive patients with acute stroke undergoing endovascular thrombectomy were retrospectively collected between 2015 to 2020 from a single-center cohort, and a systematic review was performed using PubMed, EMBASE, and Ovid MEDLINE up to June 2020.

Study selection: Articles reporting functional outcome after arterial perforation during endovascular thrombectomy were selected.

Data analysis: Functional outcomes of patients achieving successful reperfusion (TICI 2b/3) were compared with outcomes of those with unsuccessful reperfusion in our single-center cohort. We then summarized the literature review to describe interventional approaches and outcomes after arterial perforation during endovascular thrombectomy.

Data synthesis: In our single-center cohort, 1419 patients underwent endovascular thrombectomy, among whom 32 (2.3%) had vessel perforation and were included in the analysis. The most common hemostatic strategy was watchful waiting (71% of cases). Patients with successful reperfusion had a higher proportion of favorable 90-day mRS scores (60% versus 12.5%; P = .006) and a lower mortality rate (13.3% versus 56.3%, P = .01) than patients without successful reperfusion. Thirteen articles were included in the systematic review. Successful reperfusion also appeared to be associated with better outcomes.

Limitations: Given the low number of published reports, we performed only a descriptive analysis.

Conclusions: Arterial perforation during endovascular thrombectomy is rare but is associated with high mortality rates and poor outcome. However, successful reperfusion remains correlated with favorable outcome in these patients.

FIG 1.

The mRS score distribution at 90 days for patients with successful reperfusion (TICI 2b/3) and no reperfusion (TICI 0-2a), despite vessel perforation during endovascular thrombectomy.

FIG 2.

Illustrative case. A 69-year-old man with a proximal right MCA occlusion (A). B, After catheterization of M1, contrast extravasation (white arrow) was identified on microcatheter injection. C, After 10 minutes, contrast extravasation stopped spontaneously. D, Thrombectomy was pursued without further complications, and successful reperfusion was achieved. The patient had a favorable outcome at 3 months (mRS 1).