Risk factors for the development of embolism to a new territory after endovascular stroke treatment

YILMAZ, Ezgi; Görgülü, Ümit; aykaç, özlem; Uysal kocabaş, zehra; GER AKARSU, FATMA; Dogan, Baki; Ozdemir, Atilla Ozcan

doi:10.5505/tbdhd.2023.35492

Risk factors for the development of embolism to a new territory after endovascular stroke treatment

Ümit GÖRGÜLÜ, (Sağlık Bilimleri Üniversitesi, Ankara Şehir Hastanesi, Nöroloji Kliniği, Ankara, Türkiye)

Özlem AYKAÇ, (Eskisehir Osmangazi Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, Eskisehir, Türkiye)

Zehra Uysal KOCABAŞ, (Eskisehir Osmangazi Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, Eskisehir, Türkiye)

Fatma GER AKARSU, (Eskisehir Osmangazi Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, Eskisehir, Türkiye)

Baki DOĞAN, (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, Samsun, Türkiye)

Ezgi YILMAZ, (Hacettepe Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, Ankara, Türkiye)

Atilla Özcan ÖZDEMİR (Eskisehir Osmangazi Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, Eskisehir, Türkiye)

Türk Beyin Damar Hastalıkları Dergisi

1 0

Yıl: 2023 Cilt: 29 Sayı: 2 Sayfa Aralığı: 89 - 96 Metin Dili: İngilizce DOI: 10.5505/tbdhd.2023.35492 İndeks Tarihi: 27-08-2023

Risk factors for the development of embolism to a new territory after endovascular stroke treatment

Öz:

INTRODUCTION: The development of embolism to a new site (ENT) is an important complication in the endovascular treatment (EVT) of acute stroke and is associated with a poor outcome. The aim of our study was to investigate risk factors for the development of ENT. METHODS: Prospectively recorded files of patients who underwent EVT for acute stroke between 2015 and 2023 were reviewed. ENT development, demographic data, vascular risk factors, clinical findings, IV thrombolysis treatment at admission, EVT procedure modalities such as duration of the procedure, mechanical thrombectomy techniques including the use of stent retriever, balloon guiding catheter, and prognoses were evaluated for all patients. RESULTS: This study included 235 patients: 23 (9.8%) and 212 patients (90.2%) in the ENT group and non-ENT group, respectively. When comparing the case characteristic data of the two groups, the door-to-groin puncture (p=0.045) and groin puncture-to-recanalisation (p<0.001) times were longer, and the number of device passes (p<0.001) and symptomatic intracranial cerebral haemorrhage (sICH; p=0.049) increased in the ENT group. The number of device passes (OR=1.555; 95% CI 1.193–2.027; p=0.001) and and door-to-groin puncture time (OR=1.012; 95% CI 1.000–1.025; p=0.034) were identified as independent risk factors for the development of ENT. DISCUSSION AND CONCLUSION: ENT development after EVT of acute stroke is not uncommon and results in prolongation of procedure times. The number of device passes and longer door-to-groin puncture time are risk factors associated with ENT.

Anahtar Kelime:

Endovasküler inme tedavisi sonrası yeni bir bölgeye emboli gelişimi için risk faktörleri

Öz:

GİRİŞ ve AMAÇ: Yeni bir bölgede emboli (YBE), akut inmenin endovasküler tedavisinin (EVT) önemli bir komplikasyondur ve kötü sonlanım ile ilişkilidir. Çalışmamızın amacı, YBE gelişimi için risk faktörlerini araştırmaktı. YÖNTEM ve GEREÇLER: 2015 ile 2023 yılları arasında akut inme nedeniyle EVT uygulanan hastaların prospektif olarak kaydedilmiş dosyaları incelendi. Tüm hastaların YBE gelişimi, demografik verileri, vasküler risk faktörleri, klinik bulguları, başvuruda IV tromboliz tedavisi, işlem süresi gibi EVT işlem modaliteleri, stent retriever, balon kılavuz kateter kullanımını içeren mekanik trombektomi teknikleri ve prognozları değerlendirildi. BULGULAR: Bu çalışmaya YBE gelişen grupta 23 (%9,8) ve YBE gelişmeyen grupta 212 hasta (%90,2) olmak üzere 235 hasta dahil edildi. İki gruptaki vakaların karakteristik verileri karşılaştırıldığında, YBE gurubunda kapı-femoral ponksiyon (p=0,045), femoral ponksiyon-rekanalizasyon (p<0,001) süreleri daha uzun, cihaz geçiş sayısı (p<0,001) ve semptomatik intraserebral kanama (sİSK; p=0.049) daha fazlaydı. Cihaz geçiş sayısı (OR=1.534; 95% CI 1.185–0.001; p=0.001) ve femoral ponksiyon zamanı (OR=1.012; 95% CI 1.000–1.025; p=0.034) YBE gelişimi için bağımsız risk faktörleri olarak tanımlandı. TARTIŞMA ve SONUÇ: Akut inmede EVT sonrası YBE gelişimi nadir değildir ve işlem sürelerinin uzamasına neden olur. Cihaz geçiş sayısı ve uzamış femoral ponksiyon zamanı, YBE ile ilişkili risk faktörleridir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Oliveira AJF, Viana SMN, Santos AS. Mechanical thrombectomy for acute ischemic stroke: Systematic review and meta-analysis. Einstein (São Paulo) 2022; 20: eRW6642.
2. Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372(1): 11-20.
3. Saver JL, Chapot R, Agid R, et al. Distal Thrombectomy. Summit Group*†. Thrombectomy for distal, medium vessel occlusions: a consensus statement on present knowledge and promising directions. Stroke 2020; 51(9): 2872-2884.
4. Chalumeau V, Blanc R, Redjem H, et al. Anterior cerebral artery embolism during thrombectomy increases disability and mortality. J. Neurointerv Surg 2018; 10(11): 1057-1062.
5. Singh N, Cimflova P, Ospel, J, et al. Infarcts in a New Territory: Insights from the ESCAPE-NA1 Trial. Stroke 2023; 54(6): 1477-1483.
6. Qin C, Shang K, Xu SB, et al. Efficacy and safety of direct aspiration versus stent-retriever for recanalization in acute cerebral infarction: A PRISMA-compliant systematic review and meta-analysis. Medicine 2018; 97(41): e12770.
7. Gascou G, Lobotesis K, Machi P, et al. Stent retrievers in acute ischemic stroke: complications and failures during the perioperative period. Am J Neuroradiol 2014; 35(4): 734-740.
8. Kaesmacher J, Kurmann C, Jungi N, et al. Infarct in new territory after endovascular stroke treatment: A diffusion-weighted imaging study. Scientific reports 2020; 10(1): 8366.
9. Ganesh A, Al-Ajlan FS, Sabiq F, et al. Infarct in a New Territory After Treatment Administration in the ESCAPE Randomized Controlled Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times). Stroke 2016; 47(12): 2993-2998.
10. Goyal N, Tsivgoulis G, Chang JJ, et al. Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy. Journal of NeuroInterventional Surgery 2020; 12(2): 142-147.
11. Chueh JY, Puri AS, Wakhloo AK, et al. Risk of distal embolization with stent retriever thrombectomy and ADAPT. Journal of neurointerventional surgery 2016: 8(2); 197-202.
12. Kaesmacher J, Boeckh-Behrens T, Simon S, et al. Risk of thrombus fragmentation during endovascular stroke treatment. American Journal of Neuroradiology 2017; 38(5): 991-998.
13. Kurre W, Vorlaender K, Aguilar-Pérez M, et al. Frequency and relevance of anterior cerebral artery embolism caused by mechanical thrombectomy of middle cerebral artery occlusion. American Journal of Neuroradiology 2013; 34(8): 1606-1611.
14. Barber PA, Demchuk AM, Zhang J, et al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyper acute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000; 355(9216): 1670-1674.
15. Tan JC, Dillon WP, Liu S, et al. Systematic comparison of perfusion-CT and CT-angiography in acute stroke patients. Annals of neurology 2007; 61(6): 533-543.
16. Tan IYL, Demchuk AM, Hopyan J, et al. CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. American Journal of Neuroradiology 2009; 30(3): 525-531.
17. Snelling BM, Sur S, Shah SS, et al. Unfavorable vascular anatomy is associated with increased revascularization time and worse outcome in anterior circulation thrombectomy. World neurosurgery 2018; 120: e976-e983.
18. Adams Jr HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24(1): 35-41.
19. Boysen G, ECASS Study Group. European Cooperative Acute Stroke Study (ECASS): (rt PA—Thrombolysis in acute stroke) study design and progress report. European Journal of Neurology 1995; 1(3): 213-219.
20. Goyal M, Fargen KM, Turk AS, et al. 2C or not 2C: Defining an improved revascularization grading scale and the need for standardization of angiography outcomes in stroke trials. J Neurointerv Surg 2014; 6(2): 83-86.
21. Campbell BC, Mitchell PJ, Kleinig TJ, et al. EXTEND IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372(11): 1009-1018.
22. Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372(27): 2296-2306.
23. Bracard S, Ducrocq X, Louis Mas J, et al. On behalf of the THRACE investigator. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): A randomised controlled trial. Lancet Neurol 2016; 15(11): 1138-1147.
24. Serles W, Gattringer T, Mutzenbach S, et al. Austrian Stroke Unit Registry Collaborators. Endovascular stroke therapy in Austria: A nationwide 1-year experience. Eur J Neurol 2016; 23(5): 906–911.
25. Weber R, Nordmeyer H, Hadisurya J, et al. Comparison of outcome and interventional complication rate in patients with acute stroke treated with mechanical thrombectomy with and without bridging thrombolysis. J NeuroIntervent Surg 2017; 9(3): 229-233.
26. Urra X, Abilleira S, Dorado L, et al. Mechanical thrombectomy in and outside the REVASCAT trial: Insights from a concurrent population-based stroke registry. Stroke 2015; 46(12): 3437-3442.
27. Bendszus M, Koltzenburg M, Burger R, et al. Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: A prospective study. The Lancet 1999; 354(9190): 1594-1597.
28. Duffy S, McCarthy R, Farrell M, et al. Per-pass analysis of thrombus composition in patients with acute ischemic stroke undergoing mechanical thrombectomy. Stroke 2019; 50(5); 1156-1163.

APA	Görgülü Ü, aykaç ö, Uysal kocabaş z, GER AKARSU F, Dogan B, YILMAZ E, Ozdemir A (2023). Risk factors for the development of embolism to a new territory after endovascular stroke treatment. , 89 - 96. 10.5505/tbdhd.2023.35492
Chicago	Görgülü Ümit,aykaç özlem,Uysal kocabaş zehra,GER AKARSU FATMA,Dogan Baki,YILMAZ Ezgi,Ozdemir Atilla Ozcan Risk factors for the development of embolism to a new territory after endovascular stroke treatment. (2023): 89 - 96. 10.5505/tbdhd.2023.35492
MLA	Görgülü Ümit,aykaç özlem,Uysal kocabaş zehra,GER AKARSU FATMA,Dogan Baki,YILMAZ Ezgi,Ozdemir Atilla Ozcan Risk factors for the development of embolism to a new territory after endovascular stroke treatment. , 2023, ss.89 - 96. 10.5505/tbdhd.2023.35492
AMA	Görgülü Ü,aykaç ö,Uysal kocabaş z,GER AKARSU F,Dogan B,YILMAZ E,Ozdemir A Risk factors for the development of embolism to a new territory after endovascular stroke treatment. . 2023; 89 - 96. 10.5505/tbdhd.2023.35492
Vancouver	Görgülü Ü,aykaç ö,Uysal kocabaş z,GER AKARSU F,Dogan B,YILMAZ E,Ozdemir A Risk factors for the development of embolism to a new territory after endovascular stroke treatment. . 2023; 89 - 96. 10.5505/tbdhd.2023.35492
IEEE	Görgülü Ü,aykaç ö,Uysal kocabaş z,GER AKARSU F,Dogan B,YILMAZ E,Ozdemir A "Risk factors for the development of embolism to a new territory after endovascular stroke treatment." , ss.89 - 96, 2023. 10.5505/tbdhd.2023.35492
ISNAD	Görgülü, Ümit vd. "Risk factors for the development of embolism to a new territory after endovascular stroke treatment". (2023), 89-96. https://doi.org/10.5505/tbdhd.2023.35492

APA	Görgülü Ü, aykaç ö, Uysal kocabaş z, GER AKARSU F, Dogan B, YILMAZ E, Ozdemir A (2023). Risk factors for the development of embolism to a new territory after endovascular stroke treatment. Türk Beyin Damar Hastalıkları Dergisi, 29(2), 89 - 96. 10.5505/tbdhd.2023.35492
Chicago	Görgülü Ümit,aykaç özlem,Uysal kocabaş zehra,GER AKARSU FATMA,Dogan Baki,YILMAZ Ezgi,Ozdemir Atilla Ozcan Risk factors for the development of embolism to a new territory after endovascular stroke treatment. Türk Beyin Damar Hastalıkları Dergisi 29, no.2 (2023): 89 - 96. 10.5505/tbdhd.2023.35492
MLA	Görgülü Ümit,aykaç özlem,Uysal kocabaş zehra,GER AKARSU FATMA,Dogan Baki,YILMAZ Ezgi,Ozdemir Atilla Ozcan Risk factors for the development of embolism to a new territory after endovascular stroke treatment. Türk Beyin Damar Hastalıkları Dergisi, vol.29, no.2, 2023, ss.89 - 96. 10.5505/tbdhd.2023.35492
AMA	Görgülü Ü,aykaç ö,Uysal kocabaş z,GER AKARSU F,Dogan B,YILMAZ E,Ozdemir A Risk factors for the development of embolism to a new territory after endovascular stroke treatment. Türk Beyin Damar Hastalıkları Dergisi. 2023; 29(2): 89 - 96. 10.5505/tbdhd.2023.35492
Vancouver	Görgülü Ü,aykaç ö,Uysal kocabaş z,GER AKARSU F,Dogan B,YILMAZ E,Ozdemir A Risk factors for the development of embolism to a new territory after endovascular stroke treatment. Türk Beyin Damar Hastalıkları Dergisi. 2023; 29(2): 89 - 96. 10.5505/tbdhd.2023.35492
IEEE	Görgülü Ü,aykaç ö,Uysal kocabaş z,GER AKARSU F,Dogan B,YILMAZ E,Ozdemir A "Risk factors for the development of embolism to a new territory after endovascular stroke treatment." Türk Beyin Damar Hastalıkları Dergisi, 29, ss.89 - 96, 2023. 10.5505/tbdhd.2023.35492
ISNAD	Görgülü, Ümit vd. "Risk factors for the development of embolism to a new territory after endovascular stroke treatment". Türk Beyin Damar Hastalıkları Dergisi 29/2 (2023), 89-96. https://doi.org/10.5505/tbdhd.2023.35492