Thrombectomy complications in large vessel occlusions: Incidence, predictors, and clinical impact in the ETIS registry
Emmanuel Happi Ngankou
(1)
,
Benjamin Gory
(2)
,
Gaultier Marnat
(3)
,
Sébastien Richard
(4, 5, 6)
,
Romain Bourcier
(7)
,
Igor Sibon
(3)
,
Cyril Dargazanli
(8)
,
Caroline Arquizan
(9)
,
Benjamin Maïer
(10)
,
Raphaël Blanc
(10)
,
Bertrand Lapergue
(11, 12)
,
Arturo Consoli
(11, 12)
,
Stéphane Vannier
(13)
,
Laurent Spelle
(14)
,
Christian Denier
(15)
,
Marion Boulanger
(16)
,
Maxime Gauberti
(17)
,
Suzana Saleme
(18)
,
Francisco Macian
(19)
,
Frédéric Clarençon
(20)
,
Charlotte Rosso
(20)
,
Olivier Naggara
(21)
,
Guillaume Turc
(21)
,
Ozlem Ozkul-Wermester
(22)
,
Chrysanthi Papagiannaki
(23)
,
Alain Viguier
(24)
,
Christophe Cognard
(25)
,
Anthony Lebras
(26)
,
Sarah Evain
(26)
,
Valérie Wolff
(27)
,
Raoul Pop
(28)
,
Serge Timsit
(29)
,
Jean Christophe Gentric
(30)
,
Frédéric Bourdain
(31)
,
Louis Veunac
(31)
,
François Eugène
(13)
,
Stephanos Nikolaos Finitsis
(32)
,
Michel Piotin
,
Hocine Redjem
,
Simon Escalard
,
Jean Philippe Dessilles
,
François Delvoye
,
Stanislas Smajda
,
Hebert Solène
,
Mikael Mazighi
,
Mikael Obadia
,
Candice Sabben
,
Pierre Seners
,
Igor Raynouard
,
Ovide Corabianu
,
Thomas de Broucker
,
Eric Manchon
,
Guillaume Taylor
,
Malek Ben Maacha
,
Laurie Anne Thion
,
Augustin Lecler
,
Julien Savatovsjy
,
Foch Hospital
,
Adrien Wang
,
Serge Evrard
,
Maya Tchikviladze
,
Nadia Ajili
,
David Weisenburgerlile
,
Lucas Gorza
,
Géraldine Buard
,
Oguzhan Coskun
,
Federico Di Maria
,
Georges Rodesh
,
Sergio Zimatore
,
Morgan Leguen
,
Julie Gratieux
,
Fernando Pico
,
Haja Rakotoharinandrasana
,
Philippe Tassan
,
Roxanna Poll
,
Sylvie Marinier
,
Florent Gariel
,
Xavier Barreau
,
Jerome Berge
,
Patrice Menegon
,
Ludovic Lucas
,
Stéphane Olindo
,
Pauline Renou
,
Sharmila Sagnier
,
Mathilde Poli
,
Sabrina Debruxelles
,
François Rouanet
,
Thomas Tourdias
,
Jean Sebastien Liegey
,
Pierre Briau
,
Nicolas Pangon
,
Lili Detraz
,
Benjamin Daumas-Duport
,
Pierre Louis Alexandre
,
Monica Roy
,
Cédric Lenoble
,
Hubert Armand Desal
,
Benoît Guillon
,
Solène de Gaalon
,
Cécile Preterre
,
Serge Bracard
,
René Anxionnat
,
Marc Braun
,
Anne Laure Derelle
,
Tonnelet Romain
,
Liang Liao
,
François Zhu
,
Emmanuelle Schmitt
,
Sophie Planel
,
Lisa Humbertjean
,
Gioia Mione
,
Jean Christophe Lacour
,
Nolwenn Riou-Comte
,
Gérard Audibert
,
Marcela Voicu
,
Lionel Alb
,
Marie Reitter
,
Madalina Brezeanu
,
Agnès Masson
,
Adriana Tabarna
,
Iona Podar
,
Sarah Guy
,
Fatiha Bechiri
,
Pauline Bourst
,
Francisco Macian-Montoro
,
Suzanna Saleme
,
Charbel Mounayer
,
Aymeric Rouchaud
,
Laetitia Gimenez
,
Alexandre Cosnard
,
Vincent Costalat
,
Grégory Gascou
,
Pierre Henri Lefèvre
,
Imad Derraz
,
Carlos Riquelme
,
Nicolas Gaillard
,
Isabelle Mourand
,
Lucas Corti
,
Federico Cagnazzo
,
Adrien ter Schiphorst
,
Jean-Christophe Ferré
(33)
,
Hélène Raoult
,
Thomas Ronziere
,
Maria Lassale
,
Christophe Paya
,
Jean Yves Gauvrit
,
Clément Tracol
,
Sophie Langnier-Lemercier
,
Axelle Maurice
,
Sabrina Cochennec
,
Mélanie Pinault
,
Eimad Shotar
,
Nader Antoine Sourour
,
Stéphanie Lenck
,
Kévin Premat
,
Yves Samson Anne Léger
,
Sophie Crozier
,
Flore Baronnet
,
Sonia Alamowitch
,
Laure Bottin
,
Marion Yger
,
Vincent Degos
,
Olivier Chassin
,
Vanessa Chalumeau
,
Jildaz Caroff
,
Laura Venditti
,
Mariana Sarov
,
Nicolas Legris
,
Olivier Naggara
,
Wagih Ben Hassen
,
Grégoire Boulouis
,
Christine Rodriguez-Régent
,
Denis Trystram
,
Basile Kerleroux
,
Valérie Domigo
,
Catherine Lamy
,
Julia Birchenall
,
Clothilde Isabel
,
François Lun
,
Christophe Cognard
,
Anne Christine Januel
,
Jean Marc Olivot
,
Louis Fontaine
,
Nicolas Raposo
,
Fabrice Bonneville
,
Jean François Albucher
,
Lionel Calviere
,
Jean Darcourt
,
Guillaume Bellanger
,
Philippe Tall
,
Emmanuel Touzé
,
Charlotte Barbier
,
Romain Schneckenburger
,
Julien Cogez
,
Sophie Guettier
,
Julien Ognard
,
François Mathias Merrien
,
Ozlem Ozku Wermester
,
Evelyne Guégan Massardier
,
Aude Bagan Triquenot
,
Margeaux Lefebvre
,
Patricia Bernady
,
Laurent Lagoarde-Segot
,
Hélène Cailliez
,
David Higue
,
Véronique Quenardelle
,
Valérie Lauer
,
Roxana Gheoca
,
Irène Nora Pierre-Paul
,
Remy Beaujeux
,
Dan Mihoc
,
Monica Manisor
,
Julien Pottecher
,
Alain Meyer
,
Thiên Nga Chamaraux-Tran
,
Anthony Le Bras
,
Arnaud Le Guen
1
Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
2 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
3 CHU Bordeaux [Bordeaux]
4 Service de neurologie [CHRU Nancy]
5 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
6 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
7 CHU Nantes - Centre hospitalier universitaire de Nantes
8 Neuroradiologie [Hôpital Gui de Chauliac]
9 Hôpital Gui de Chauliac [CHU Montpellier]
10 CHU Rothschild [AP-HP]
11 Service Neuroradiologie diagnostique et interventionnelle [Hôpital Foch]
12 UVSQ Santé - Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil
13 Service de Neurologie [CHU Rennes]
14 Service de Neuroradiologie [CHU de Bicêtre]
15 Service de neurologie [Le Kremlin Bicêtre]
16 Service de Neurologie [CHU Caen]
17 Départment de Neuroradiologie [CHU Caen]
18 Service de Neuroradiologie interventionnelle [CHU Limoges]
19 Service de Neurologie [CHU Limoges]
20 CHU Pitié-Salpêtrière [AP-HP]
21 Service de Neurologie [CH Saint-Anne]
22 Service de neurologie [Rouen]
23 Département de Neuroradiologie [CHU Rouen]
24 Neurologie Vasculaire [Toulouse]
25 Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
26 Service de radiologie [Vannes]
27 Service de Neurologie [Strasbourg]
28 Département de Neuroradiologie [Strasbourg]
29 Service de Neurologie [Brest]
30 Service de Neuroradiologie [Brest]
31 Neurologie - Côte Basque
32 Aristotle University of Thessaloniki
33 Empenn - Neuroimagerie: méthodes et applications
2 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
3 CHU Bordeaux [Bordeaux]
4 Service de neurologie [CHRU Nancy]
5 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
6 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
7 CHU Nantes - Centre hospitalier universitaire de Nantes
8 Neuroradiologie [Hôpital Gui de Chauliac]
9 Hôpital Gui de Chauliac [CHU Montpellier]
10 CHU Rothschild [AP-HP]
11 Service Neuroradiologie diagnostique et interventionnelle [Hôpital Foch]
12 UVSQ Santé - Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil
13 Service de Neurologie [CHU Rennes]
14 Service de Neuroradiologie [CHU de Bicêtre]
15 Service de neurologie [Le Kremlin Bicêtre]
16 Service de Neurologie [CHU Caen]
17 Départment de Neuroradiologie [CHU Caen]
18 Service de Neuroradiologie interventionnelle [CHU Limoges]
19 Service de Neurologie [CHU Limoges]
20 CHU Pitié-Salpêtrière [AP-HP]
21 Service de Neurologie [CH Saint-Anne]
22 Service de neurologie [Rouen]
23 Département de Neuroradiologie [CHU Rouen]
24 Neurologie Vasculaire [Toulouse]
25 Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
26 Service de radiologie [Vannes]
27 Service de Neurologie [Strasbourg]
28 Département de Neuroradiologie [Strasbourg]
29 Service de Neurologie [Brest]
30 Service de Neuroradiologie [Brest]
31 Neurologie - Côte Basque
32 Aristotle University of Thessaloniki
33 Empenn - Neuroimagerie: méthodes et applications
Benjamin Gory
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Gaultier Marnat
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Sébastien Richard
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Olivier Naggara
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Guillaume Turc
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Raoul Pop
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François Eugène
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Stephanos Nikolaos Finitsis
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Simon Escalard
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François Delvoye
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Foch Hospital
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Adrien Wang
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Maya Tchikviladze
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Nadia Ajili
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David Weisenburgerlile
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Lucas Gorza
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Géraldine Buard
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Federico Di Maria
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Sergio Zimatore
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Mathilde Poli
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Marc Braun
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Liang Liao
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Marcela Voicu
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Adrien ter Schiphorst
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Hélène Raoult
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Maria Lassale
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François Mathias Merrien
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Ozlem Ozku Wermester
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Evelyne Guégan Massardier
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Aude Bagan Triquenot
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Margeaux Lefebvre
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Patricia Bernady
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Dan Mihoc
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Julien Pottecher
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Alain Meyer
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Thiên Nga Chamaraux-Tran
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Anthony Le Bras
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Arnaud Le Guen
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Abstract
BACKGROUND AND PURPOSE: Procedural complications in thrombectomy for large vessel occlusions of the anterior circulation are not well described. We investigated the incidence, risk factors, and clinical implications of thrombectomy complications in daily clinical practice. METHODS: We used data from the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France. The present study is a retrospective analysis of 4029 stroke patients with anterior large vessel occlusions treated with thrombectomy between January 2015 and May 2020 in 18 centers. We systematically collected procedural data, incidence of embolic complications, perforations and dissections, clinical outcome at 90 days, and hemorrhagic complications. RESULTS: Procedural complications occurred in 7.99% (95% CI, 7.17%–8.87%), and embolus to a new territory (ENT) was the most frequent (5.2%). Predictors of ENTs were terminal carotid/tandem occlusion (odds ratio [OR], 5 [95% CI, 2.03–12.31]; P<0.001) and an increased total number of passes (OR, 1.22 [95% CI, 1.05–1.41]; P=0.006). ENTs were associated to worse clinical outcomes (90-day modified Rankin Scale score, 0–2; adjusted OR, 0.4 [95% CI, 0.25–0.63]; P<0.001), increased mortality (adjusted OR, 1.74 [95% CI, 1.2–2.53]; P<0.001), and symptomatic intracerebral hemorrhage (adjusted OR, 1.87 [95% CI, 1.15–3.03]; P=0.011). Perforations occurred in 1.69% (95% CI, 1.31%–2.13%). Predictors of perforations were terminal carotid/tandem occlusions (39.7% versus 27.6%; P=0.028). 40.7% of patients died at 90 days, and the overall rate of poor outcome was 74.6% in case of perforation. Dissections occurred in 1.46% (95% CI, 1.11%–1.88%) and were more common in younger patients (median age, 64.2 versus 70.2 years; P=0.002). Dissections did not affect the clinical outcome at 90 days. Besides dissection, complications were independent of the thrombectomy technique. CONCLUSIONS: Thrombectomy complication rate is not negligible, and ENTs were the most frequent. ENTs and perforations were associated with disability and mortality, and terminal carotid/tandem occlusions were a risk factor.