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

Abstract Background 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 DSA and functional outcome, using a large EVT registry. Methods We included all patients in the MR CLEAN Registry who underwent EVT. We used digital subtraction angiography (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 (mRS) 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 1.9 [95%CI 1.2-3.1]) and distal occlusion locations (aOR 2.2 [95%CI 1.4-3.7]) were associated with increased risk of vessel perforation. Functional outcome was worse in patients with vessel perforation (acOR 0.41, 95%CI 0.25-0.68) compared to patients without a vessel perforation. No significant association was found between location of perforation or successful reperfusion and functional outcome. Conclusion The incidence of vessel perforation during EVT is low, but it has severe clinical consequences. Females and patients with a distal occlusion locations are at higher risk. The location of vessel perforation or successful reperfusion did not affect functional outcome.