Access-Site Complications in Mechanical Thrombectomy for Acute Ischemic Stroke: A Review of Prospective Trials

Article Figures & Data

Table 1:

Summary of clinical trial methodology

Study	Device Used	Time since Stroke-Symptom Onset	Vessels	IV tPA	IA tPA
SWIFT¹⁹^{^a}	Solitaire FR (Covidien, Irvine, California); Merci Retriever (Concentric Medical, Mountain View, California)	<8 hr	Large-vessel occlusion	Contraindicated or failed	Excluded
ESCAPE²⁰^{^b}	Any approved neurothrombectomy device	<12 hr	Large-vessel occlusion	Yes	Unspecified
REVASCAT²¹^{^c}	Solitaire FR	<8 hr	Anterior circulation occlusion	Yes	Allowed
EXTEND IA²²^{^d}	Solitaire FR	<4.5 hr	Anterior circulation occlusion	Yes	Unspecified
DAWN²³^{^e}	Trevo retriever (Stryker, Kalamazoo, Michigan)	6–24 hr	Anterior circulation occlusion	Contraindicated or failed	Excluded
MR RESCUE²⁴^{^f}	Merci or Penumbra System (Penumbra, Alameda, California)	<8 hr	Large-vessel occlusion	Yes	Allowed
THRACE²⁵^{^g}	Any approved neurothrombectomy device	<5 hr	Large-vessel occlusion	Yes	Allowed

Note:—IA indicates intra-arterial.
a Solitaire With the Intention For Thrombectomy (SWIFT).
↵b Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE).
↵c Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours (REVASCAT).
↵d Extending the Time for Thrombolysis in Emergency Neurological Deficits—Intra-Arterial (EXTEND-IA).
↵e Clinical Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention With Trevo (DAWN).
↵f Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE).
↵g Trial and Cost Effectiveness Evaluation of Intra-arterial Thrombectomy in Acute Ischemic Stroke (THRACE).

Table 2:

Access-site complication rates

Trial	Non-Major AEs	Serious AEs	TAEs
SWIFT^{^a}	NA	4/144 (2.78%)	NA
ESCAPE^{^b}	12/165 (7.27%)	2/165 (1.21%)	14/165 (8.48%)
REVASCAT^{^c}	NA	NA	12/103 (11.65%)
EXTEND-IA^{^d}	NA	1/35 (2.86%)	NA
DAWN^{^e}	NA	1/107 (0.93%)	NA
MR RESCUE^{^f}	NA	0/64 (0%)	NA
THRACE^{^g}	NA	3/145 (2.07%)	NA

Note:—NA indicates not applicable; AE, adverse event; TAE, total adverse event.
↵a No AE reported. Table 1 reports 4 groin complications; Table 5 reports 9 major adverse events at the access site.
↵b Serious adverse events resulted in death, prolonged hospital stays, re-admission, or were severe or life-threatening. All minor events consisted of femoral hematomas.
↵c TAEs are not stratified on the basis of whether they were AEs or major adverse events.
↵d No AE reported. A major adverse event was a groin hematoma requiring transfusion.
↵e No AE reported. A major adverse event was a vessel puncture-site hemorrhage requiring intervention.
↵f No AE reported. A major adverse event consisted of 1 vessel dissection, though the vessel was not specified. There were no groin hematomas requiring intervention.
↵g No AE reported. Dissections and arterial perforations do not indicate a vessel.