Abstract
OBJECTIVE: Mechanical thrombectomy has become an established treatment for acute ischemic stroke caused by acute intracranial artery occlusion, but periprocedural complications may adversely affect outcomes. This study aimed to identify clinical and procedural factors associated with periprocedural complications following mechanical thrombectomy and to clarify their impact on prognosis. METHODS: We conducted a multicenter observational study of patients who underwent mechanical thrombectomy for acute intracranial artery occlusion between January 2016 and June 2022 across 11 stroke centers in Fukushima Prefecture, Japan. Data were collected from a retrospective registry (January 2016-December 2019) and a prospective registry (January 2020-June 2022). Periprocedural complications were defined as adverse events occurring during or within 24 h after the procedure, including hemorrhagic, ischemic, device-related, and extracranial complications. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of periprocedural complications. RESULTS: A total of 487 patients were included in the analysis. Periprocedural complications occurred in 66 patients (13.6%). The most frequent procedure-related events were perforator injury (n = 18, 3.7%), vessel perforation (n = 9), and contrast-induced hemorrhage (n = 4). Post-procedural complications mainly included hemorrhagic transformation (n = 16). Compared with patients without complications, those with complications had a higher prevalence of atrial fibrillation (62.1% vs. 46.6%, p = 0.019), less frequent intravenous recombinant tissue plasminogen activator use (37.9% vs. 52.0%, p = 0.033), and longer puncture to recanalization time (76.5 vs. 57 min, p = 0.012). Symptomatic intracranial hemorrhage occurred exclusively in the complication group (31.8% vs. 0%, p <0.001). Patients with complications had a lower rate of favorable functional outcomes (modified Rankin Scale score 0-2 at 90 days, 18.2% vs. 42.6%, p <0.001). Multivariable analysis identified atrial fibrillation (odds ratio [OR] 1.885, 95% confidence interval [CI] 1.084-3.276, p = 0.025) and prolonged procedure time (per minute; OR 1.007, 95% CI 1.001-1.013, p = 0.017) as independent predictors of periprocedural complications. CONCLUSION: Atrial fibrillation and longer procedure time were independently associated with periprocedural complications. Perforator injury and hemorrhagic transformation were major contributors to adverse events, with symptomatic intracranial hemorrhage leading to severe disability or death in most affected patients.