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Research ArticleNeurointervention

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

C. Ducroux, W. Boisseau, A.Y. Poppe, N. Daneault, Y. Deschaintre, J.D.B. Diestro, J. Eneling, L.C. Gioia, D. Iancu, B. Maier, B. Nauche, L. Nico, C. Odier, J. Raymond, D. Roy, C. Stapf, A. Weill and G. Jacquin
American Journal of Neuroradiology November 2022, 43 (11) 1633-1638; DOI: https://doi.org/10.3174/ajnr.A7650
C. Ducroux
aFrom the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
bDepartments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
eDivision of Neurology (C.D.), Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
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W. Boisseau
cRadiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
gDepartment of Interventional Neuroradiology (W.B., B.M.), Hopital Fondation A. De Rothschild, Paris, France
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A.Y. Poppe
aFrom the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
bDepartments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
dNeurovascular Group (A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.), Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
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N. Daneault
aFrom the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
bDepartments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
dNeurovascular Group (A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.), Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
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Y. Deschaintre
aFrom the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
bDepartments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
dNeurovascular Group (A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.), Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
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  • ORCID record for Y. Deschaintre
J.D.B. Diestro
cRadiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
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J. Eneling
cRadiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
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L.C. Gioia
aFrom the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
bDepartments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
dNeurovascular Group (A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.), Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
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D. Iancu
cRadiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
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B. Maier
cRadiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
gDepartment of Interventional Neuroradiology (W.B., B.M.), Hopital Fondation A. De Rothschild, Paris, France
hUniversité Paris-Cité (B.M.), Paris, France
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B. Nauche
fBibliothèque du Centre Hospitalier de l’Université de Montréal (B.N.), Montreal, Quebec, Canada
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L. Nico
cRadiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
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C. Odier
aFrom the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
bDepartments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
dNeurovascular Group (A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.), Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
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J. Raymond
cRadiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
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D. Roy
cRadiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
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C. Stapf
aFrom the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
bDepartments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
dNeurovascular Group (A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.), Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
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A. Weill
cRadiology (W.B., J.D.B.D., J.E., D.I., B.M., L.N., J.R., D.R., A.W.)
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G. Jacquin
aFrom the Department of Neurosciences (C.D., A.Y.P., N.D., Y.D. L.C.G., C.O., C.S., G.J.), Faculté de médecine, Université de Montréal, Montréal, Quebec. Canada
bDepartments of Medicine (Neurology) (C.D., A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.)
dNeurovascular Group (A.Y.P., N.D., Y.D., L.C.G., C.O., C.S., G.J.), Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
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    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.
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    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).

Tables

  • Figures
  • Outcomes of patients with procedural perforation with successful reperfusion (mTICI ≥ 2b/3) and with unsuccessful reperfusion (mTICI < 2b/3)a

    Follow-upAll Patients (n = 32)mTICI < 2b (n = 16)mTICI ≥ 2b (n = 16)P Values
    Efficacy outcomes
     NIHSS day 118 (9–24)22 (219–24)13 (59–21).04
     mRS at 3 monthsb4 (29–6)6 (49–6)2 (1.59–5).01
     Favorable outcome (mRS, 0–2)11 (34.4)2 (12.5)9 (60.0).006
     Death at 3 mo11 (34.4)9 (56.3)2 (13.3).01
    Safety outcomes
     Any hemorrhagic transformation15 (46.9)6 (40.0)9 (56.3).4
     sICH6 (18.8)3 (20.0)3 (18.8).7
     SAH28 (87.5)14 (93)14 (87.5).6
    • ↵a Values are presented as No. (%), mean (SD), or median (IQR).

    • ↵b Follow-up at 3 months was unavailable for 1 patient in the unsuccessful reperfusion group.

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American Journal of Neuroradiology: 43 (11)
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C. Ducroux, W. Boisseau, A.Y. Poppe, N. Daneault, Y. Deschaintre, J.D.B. Diestro, J. Eneling, L.C. Gioia, D. Iancu, B. Maier, B. Nauche, L. Nico, C. Odier, J. Raymond, D. Roy, C. Stapf, A. Weill, G. Jacquin
Successful Reperfusion is Associated with Favorable Functional Outcome despite Vessel Perforation during Thrombectomy: A Case Series and Systematic Review
American Journal of Neuroradiology Nov 2022, 43 (11) 1633-1638; DOI: 10.3174/ajnr.A7650

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Reperfusion and Outcome After Thrombectomy
C. Ducroux, W. Boisseau, A.Y. Poppe, N. Daneault, Y. Deschaintre, J.D.B. Diestro, J. Eneling, L.C. Gioia, D. Iancu, B. Maier, B. Nauche, L. Nico, C. Odier, J. Raymond, D. Roy, C. Stapf, A. Weill, G. Jacquin
American Journal of Neuroradiology Nov 2022, 43 (11) 1633-1638; DOI: 10.3174/ajnr.A7650
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