Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Clinical Neuroradiology
Published in: Clinical Neuroradiology 2/2015

01-06-2015 | Original Article

Peri-interventional Subarachnoid Hemorrhage During Mechanical Thrombectomy with stent retrievers in Acute Stroke: A Retrospective Case-Control Study

Authors: U. Yilmaz, MD, S. Walter, MD, H. Körner, MD, P. Papanagiotou, MD, C. Roth, MD, A. Simgen, S. Behnke, MD, A. Ragoschke-Schumm, MD, K. Fassbender, MD, W. Reith, MD

Published in: Clinical Neuroradiology | Issue 2/2015

Login to get access

Abstract

Background

Mechanical thrombectomy with stent retrievers in acute stroke has emerged as a promising new technique with the highest recanalization rate of the therapeutic procedures available so far. However, endovascular treatment is also associated with the risk of specific complications. One of those is the occurrence of peri-interventional subarachnoid hemorrhage (SAH), which has been reported in 5–16 % of the cases. Interestingly, this rate is higher than that of angiographically detectable perforations (0–3 %), leaving the majority of peri-interventional SAH to be due to angiographically occult perforations. Little is known about the influence of this finding on clinical outcome. The purpose of this study was to investigate the clinical relevance of SAH due to occult perforations during thrombectomy with stent retrievers.

Methods

Postinterventional computed tomography (CT) scans of 217 consecutive patients with acute occlusions of intracerebral arteries who were treated with stent retrievers in our department between October 2009 and October 2012 were retrospectively analyzed.

Results

SAH was found on postinterventional CT scans in 5.5 % of the cases. Seven cases were included for further analysis and matched to controls by the following characteristics: (1) site of occlusion, (2) result of the recanalization procedure according to the modified thrombolysis in cerebral infarction score, (3) administration of intravenous recombinant tissue plasminogen activator, (4) presence of proximal extracranial occlusion, (5) age, and (6) sex. Comparison of the angiographic data of the two cohorts showed no significant difference in the length of the procedures or the number of maneuvers needed for recanalization, nor were there significant differences in clinical outcomes as measured by NIHSS and mRS scores. Secondary symptomatic ICH occurred in one case in either cohort and led to death in both cases. The rate of asymptomatic ICH within the first 24 h after recanalization was significantly higher in the group with peri-interventional SAH (57 vs. 0 %, P = 0.018).

Conclusions

This small retrospective case-control study did not reveal a significant influence of peri-interventional SAH due to angiographically occult perforations on neurologic outcome of patients treated with stent retrievers.
Literature
1.
Castaño C, Dorado L, Guerrero C, Millán M, Gomis M, Perez de la Ossa N, Castellanos M, García MR, Domenech S, Dávalos A. Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation: a pilot study. Stroke. 2010;41:1836–40.PubMedCrossRef
2.
Stampfl S, Hartmann M, Ringleb PA, Haehnel S, Bendszus M, Rohde S. Stent placement for flow restoration in acute ischemic stroke: a single-center experience with the solitaire stent system. AJNR Am J Neuroradiol. 2011;32:1245–8.PubMedCrossRef
3.
Roth C, Papanagiotou P, Behnke S, Walter S, Haass A, Becker C, Fassbender K, Politi M, Körner H, Romann MS, Reith W. Stent-assisted mechanical recanalization for treatment of acute intracerebral artery occlusions. Stroke. 2010;41:2559–67.PubMedCrossRef
4.
Dorn F, Stehle S, Lockau H, Zimmer C, Liebig T. Endovascular treatment of acute intracerebral artery occlusions with the solitaire stent: single-centre experience with 108 recanalization procedures. Cerebrovasc Dis. 2012;34:70–7.PubMedCrossRef
5.
Dávalos A, Pereira VM, Chapot R, Bonafé A, Andersson T, Gralla J; Solitaire Group. Retrospective multicenter study of Solitaire FR for revascularization in the treatment of acute ischemic stroke. Stroke. 2012;43:2699–705.PubMedCrossRef
6.
Jansen O, Macho JM, Killer-Oberpfalzer M, Liebeskind D, Wahlgren N. Neurothrombectomy for the treatment of acute ischemic stroke: results from the TREVO study. Cerebrovasc Dis. 2013;36:218–25.PubMedCrossRef
7.
Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, Clark W, Budzik R, Zaidat OO; SWIFT Trialists. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet. 2012;380:1241–9.PubMedCrossRef
8.
Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, Liebeskind DS, Smith WS; TREVO 2 Trialists. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet. 2012;380(9849):1231–40.PubMedCentralPubMedCrossRef
9.
Akins PT, Amar AP, Pakbaz RS, Fields JD; on behalf of the SWIFT Investigators. Complications of endovascular treatment for acute stroke in the SWIFT trial with Solitaire and Merci devices. AJNR Am J Neuroradiol. 2013 Sep 12. Epub ahead of print.
10.
Yoon W, Jung MY, Jung SH, Park MS, Kim JT, Kang HK. Subarachnoid hemorrhage in a multimodal approach heavily weighted toward mechanical thrombectomy with solitaire stent in acute stroke. Stroke. 2013;44(2):414–9.PubMedCrossRef
11.
Tomsick T, Broderick J, Carrozella J, Khatri P, Hill M, Palesch Y, Khoury J; Interventional Management of Stroke II Investigators. Revascularization results in the Interventional Management of Stroke II trial. AJNR Am J Neuroradiol. 2008;29:582–7.PubMedCentralPubMedCrossRef
12.
Bar M, Mikulik R, Jonszta T, Krajina A, Roubec M, Skoloudik D, Prochazka V. Diagnosis of recanalization of the intracranial artery has poor inter-rater reliability. AJNR Am J Neuroradiol. 2012;33:972–4.PubMedCrossRef
Metadata
Title
Peri-interventional Subarachnoid Hemorrhage During Mechanical Thrombectomy with stent retrievers in Acute Stroke: A Retrospective Case-Control Study
Authors
U. Yilmaz, MD
S. Walter, MD
H. Körner, MD
P. Papanagiotou, MD
C. Roth, MD
A. Simgen
S. Behnke, MD
A. Ragoschke-Schumm, MD
K. Fassbender, MD
W. Reith, MD
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
Clinical Neuroradiology / Issue 2/2015
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-014-0294-6

Other articles of this Issue 2/2015

Clinical Neuroradiology 2/2015 Go to the issue

Correspondence

Multifocal Signal Loss at Bridging Veins on Susceptibility-Weighted Imaging in Abusive Head Trauma

Original Article

Posterior Reversible Encephalopathy Syndrome: The Spectrum of MR Imaging Patterns

Review Article

Cavernous Sinus: A Comprehensive Review of its Anatomy, Pathologic Conditions, and Imaging Features

Correspondence

Quantitative Measurements of Cerebral Circulation in Spontaneously Regressing Traumatic Carotid-Cavernous Sinus Fistula with Velocity-Encoded Magnetic Resonance Imaging

Correspondence

Early Fatal Hemorrhage After Endovascular Treatment of a Giant Aneurysm with Flow Diverter Device and Coils

Original Article

Prevalence of Temporal Bone Fractures in Patients with Mandibular Fractures Using Multidetector-Row CT