Petechial hemorrhage in mechanical thrombectomy for distal and medium-vessel occlusions: technical considerations and outcomes

Muhammed Amir Essibayi; Hamza Adel Salim; Melissa J Fazzari; Deepak Khatri; Amanda Baker; Basel Musmar; Nimer Adeeb; Nils Henninger; Sri Hari Sundararajan; Anna Luisa Kühn; Jane Khalife; Sherief Ghozy; Luca Scarcia; Leonard L L Yeo; Benjamin Y Q Tan; Robert W Regenhardt; Jeremy J Heit; Nicole M Cancelliere; Aymeric Rouchaud; Jens Fiehler; Sunil A Sheth; Ajit S Puri; Christian Dyzmann; Marco Colasurdo; Leonardo Renieri; João Pedro Filipe; Pablo Harker; Yasmin Aziz; Răzvan Alexandru Radu; Mohamad Abdalkader; Piers Klein; Thomas R Marotta; Julian Spears; Takahiro Ota; Ashkan Mowla; Kareem El Naamani; Pascal Jabbour; Arundhati Biswas; Frédéric Clarençon; James E Siegler; Thanh N Nguyen; Ricardo Varela; Nestor R Gonzalez; Markus A Möhlenbruch; Vincent Costalat; Benjamin Gory; Vivek Yedavalli; Christian Paul Stracke; Constantin Hecker; Gaultier Marnat; Hamza Shaikh; Christoph J Griessenauer; David S Liebeskind; Alessandro Pedicelli; Andrea M Alexandre; Tobias D Faizy; Illario Tancredi; Erwah Kalsoum; Boris Lubicz; Aman B Patel; Vitor Mendes Pereira; Adrien Guenego; Adam A Dmytriw; David J Altschul; MAD MT Investigators

doi:10.3171/2025.3.JNS243030

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Petechial hemorrhage in mechanical thrombectomy for distal and medium-vessel occlusions: technical considerations and outcomes

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Petechial hemorrhage in mechanical thrombectomy for distal and medium-vessel occlusions: technical considerations and outcomes

Muhammed Amir Essibayi, Hamza Adel Salim, Melissa J Fazzari, Deepak Khatri, Amanda Baker, Basel Musmar, Nimer Adeeb, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, …

Journal of neurosurgery, Vol.143(6), pp.1501-1513

01/12/2025

DOI: https://doi.org/10.3171/2025.3.JNS243030

PMID: 40614268

Résumé

Aged

Aged, 80 and over

Cerebral Hemorrhage - etiology

Cohort Studies

Female

Humans

Ischemic Stroke - surgery

Male

Middle Aged

Retrospective Studies

Thrombectomy - adverse effects

Thrombectomy - methods

Treatment Outcome

Mechanical thrombectomy (MT) is well established for large-vessel occlusion (LVO) strokes, but its safety in distal and medium-vessel occlusions (DMVOs) requires further investigation. This study analyzed the relationship between procedural approaches, petechial hemorrhage (PetH), and clinical outcomes in DMVO thrombectomy, with particular attention to technical considerations and the complex interplay between tissue injury and hemorrhagic complications. A retrospective cohort study was conducted on DMVO stroke patients treated with MT at 37 stroke centers worldwide from 2016 to 2024. Patients were categorized based on follow-up imaging into those with or without PetH. Four logistic regression models analyzed the association of PetH with favorable functional outcomes (modified Rankin Scale score ≤ 2) at 90 days, early neurological improvement (≥ 4-point National Institutes of Health Stroke Scale score decrease at 24 hours), all-cause mortality, and independent determinants of PetH. Adjusted odds ratios (aORs), 95% confidence intervals, and p values were reported. Of 1428 patients, 439 (30.7%) developed PetH. Factors independently associated with PetH were multiple thrombectomy passes (aOR 1.58, 95% CI 1.21-2.06; p = 0.001), IV thrombolysis (aOR 1.31, 95% CI 1.01-1.69; p = 0.04), and the combined use of a stent retriever with aspiration as the first-line method compared with aspiration alone (aOR 1.66, 95% CI 1.15-2.38; p = 0.007). Conversely, general anesthesia (aOR 0.55, 95% CI 0.40-0.77; p < 0.001), higher Alberta Stroke Program Early CT Scores (aOR 0.76, 95% CI 0.69-0.83; p < 0.001), and successful recanalization (aOR 0.56, 95% CI 0.39-0.80; p = 0.002) were significantly associated with a lower odds of PetH. PetH was associated with a decreased odds of favorable functional outcomes (aOR 0.51, 95% CI 0.36-0.73; p < 0.001), reduced early neurological improvement (aOR 0.59, 95% CI 0.44-0.79; p < 0.001), and increased all-cause mortality (aOR 1.84, 95% CI 1.23-2.76; p < 0.001). PetH is a frequent sequela following MT in DMVO strokes and is associated with poorer outcomes, likely reflecting underlying ischemic injury rather than direct causation. Procedural factors influence PetH risk, suggesting medical treatment as first-line therapy for DMVOs, with MT reserved for refractory cases using less aggressive approaches.

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Titre: Petechial hemorrhage in mechanical thrombectomy for distal and medium-vessel occlusions: technical considerations and outcomes
Créateurs - sans rôle: Muhammed Amir Essibayi - Albert Einstein College of Medicine
Hamza Adel Salim - Brigham and Women's Hospital
Melissa J Fazzari - 43Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
Deepak Khatri - 1Department of Neurological Surgery, Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
Amanda Baker - Albert Einstein College of Medicine
Basel Musmar - Thomas Jefferson University
Nimer Adeeb - University of New Orleans
Nils Henninger - University of Massachusetts Chan Medical School
Sri Hari Sundararajan - 7Department of Endovascular Neurosurgery and Neuroradiology, New Jersey Medical School, Newark, New Jersey
Anna Luisa Kühn - 8Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
Jane Khalife - Cooper University Hospital
Sherief Ghozy - Mayo Clinic
Luca Scarcia - 11Department of Neuroradiology, Henri Mondor Hospital, Créteil, France
Leonard L L Yeo - 12Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Benjamin Y Q Tan - 13Division of Neurology, Department of Medicine, National University Hospital, Singapore
Robert W Regenhardt - Brigham and Women's Hospital
Jeremy J Heit - 14Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California
Nicole M Cancelliere - University of Toronto
Aymeric Rouchaud - Centre Hospitalier Universitaire de Limoges
Jens Fiehler - University Medical Center Hamburg-Eppendorf
Sunil A Sheth - The University of Texas Health Science Center at Houston
Ajit S Puri - 8Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
Christian Dyzmann - 19Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany
Marco Colasurdo - University of Portland
Leonardo Renieri - 21Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
João Pedro Filipe - 22Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Portugal
Pablo Harker - University of Cincinnati Medical Center
Yasmin Aziz - University of Cincinnati Medical Center
Răzvan Alexandru Radu - 24Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
Mohamad Abdalkader
Piers Klein
Thomas R Marotta - University of Toronto
Julian Spears - 15Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada
Takahiro Ota - Tokyo Metropolitan Tama Medical Center
Ashkan Mowla - 27Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, California
Kareem El Naamani - Thomas Jefferson University
Pascal Jabbour - Thomas Jefferson University
Arundhati Biswas - Westchester Medical Center
Frédéric Clarençon - Pitié-Salpêtrière Hospital
James E Siegler - Cooper University Hospital
Thanh N Nguyen
Ricardo Varela - 30Department of Neurology, Centro Hospitalar Universitário do Porto, Portugal
Nestor R Gonzalez - Cedars-Sinai Medical Center
Markus A Möhlenbruch - 32Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Germany
Vincent Costalat - 24Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
Benjamin Gory - Université de Lorraine
Vivek Yedavalli - 2Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland
Christian Paul Stracke - 35Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Germany
Constantin Hecker - Paracelsus Medical University
Gaultier Marnat - 37Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
Hamza Shaikh - Cooper University Hospital
Christoph J Griessenauer - Paracelsus Medical University
David S Liebeskind - 47Department of Neurology, University of California, Los Angeles, California
Alessandro Pedicelli - 39UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Andrea M Alexandre - 39UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Tobias D Faizy - 40Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany
Illario Tancredi - 41Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
Erwah Kalsoum - 11Department of Neuroradiology, Henri Mondor Hospital, Créteil, France
Boris Lubicz - Universitair Ziekenhuis Brussel
Aman B Patel - Brigham and Women's Hospital
Vitor Mendes Pereira - University of Toronto
Adrien Guenego - Universitair Ziekenhuis Brussel
Adam A Dmytriw - University of Toronto
David J Altschul - Albert Einstein College of Medicine
MAD MT Investigators
Détails de publication: Journal of neurosurgery, Vol.143(6), pp.1501-1513
Identifiants: 99163063709311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article