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Published in: Clinical Neuroradiology 1/2019

Open Access 01-03-2019 | Original Article

Iatrogenic Vessel Dissection in Endovascular Treatment of Acute Ischemic Stroke

Authors: Barbara Goeggel Simonetti, Justine Hulliger, Etienne Mathier, Simon Jung, Urs Fischer, Hakan Sarikaya, Johannes Slotboom, Gerhard Schroth, Pasquale Mordasini, Jan Gralla, Marcel Arnold

Published in: Clinical Neuroradiology | Issue 1/2019

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Abstract

Purpose

Knowledge about the localization and outcome of iatrogenic dissection (ID) during endovascular treatment of acute ischemic stroke (AIS) is limited. We aimed to determine the frequency, clinical aspects and morphology of ID in endovascular AIS treatment and to identify predictors of this complication.

Methods

Digital subtraction angiography (DSA) of ID carried out during endovascular treatment between January 2000 and March 2012 have been re-evaluated. The ID localization and morphology were analyzed and related to the interventional techniques. Baseline clinical and radiological findings, treatment modality and outcome were compared with patients without ID.

Results

Out of 866 patients 18 (2%) suffered an ID (44% female, median age 64 years). Localization was extracranial in 15 (83%, 14 internal carotid artery and 1 vertebral artery) and intracranial in 3 (17%; 1 vertebrobasilar dissection and 2 in the anterior circulation). Of the IDs 5 (28%) resulted in a high-degree, 3 (17%) in a moderate, 5 (28%) in a mild and 5 (28%) in no stenosis and 8 IDs were stented in the acute phase. At 3 months 7 (42%) patients had a favorable outcome (modified Rankin score mRS ≤ 2) and 6 (33%) patients had died. Patients with ID had a different stroke etiology (p = 0.041), were more likely to be smokers (44% versus 19%, p = 0.015) and were more likely to be treated with mechanical thrombectomy (100% versus 60%, p < 0.001). Although two ID patients had relevant complications, the outcome did not differ between the groups.

Conclusion

The occurrence of ID is a rare complication of endovascular AIS treatment associated with smoking and mechanical thrombectomy.
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Metadata
Title
Iatrogenic Vessel Dissection in Endovascular Treatment of Acute Ischemic Stroke
Authors
Barbara Goeggel Simonetti
Justine Hulliger
Etienne Mathier
Simon Jung
Urs Fischer
Hakan Sarikaya
Johannes Slotboom
Gerhard Schroth
Pasquale Mordasini
Jan Gralla
Marcel Arnold
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
Clinical Neuroradiology / Issue 1/2019
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-017-0639-z

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