Iatrogenic Vessel Dissection in Neuroendovascular Therapy: A JR-NET4 Nationwide Registry Analysis.

Authors

Natsuhi Sasaki, Akira Ishii, Hirotoshi Imamura, Tetsu Satow, Chiaki Sakai, Koji Iihara, Shinichi Yoshimura, Yuji Matsumaru, Nobuyuki Sakai, Japanese Registry of Neuroendovascular Therapy 4 (JR-NET4) Investigators

Published in

AJNR. American journal of neuroradiology. Sep 03, 2026. Epub Sep 03, 2026.

Abstract

Iatrogenic vessel dissection is an uncommon complication of neuroendovascular therapy. Owing to its low incidence, procedure-specific incidence and associated factors have remained incompletely defined. While iatrogenic vessel dissection typically follows a benign course, severe outcomes have occasionally been reported, and the determinants of this exceptional course are unclear. We aimed to establish procedure-specific benchmark incidence, identify associated factors, and assess its outcome impact using a large nationwide registry.
We conducted a retrospective analysis using the Japanese Registry of Neuroendovascular Therapy 4, covering 2015-2019. Dissection incidence, associated baseline and procedural factors, and 30-day functional outcomes were evaluated across nine treatment categories. Procedure-specific multivariable logistic regression was used to estimate adjusted associations with 30-day mRS. Among dissection cases without other complications (isolated dissection), secondary intracranial hemorrhage or cerebral infarction and their associations with outcomes were explored. These analyses were also conducted separately for intracranial and extracranial treatment sites.
A total of 53,402 procedures were included. Overall incidence was 0.65% (348 procedures), ranging from 0.12% in vasospasm treatment to 3.48% in intracranial angioplasty/stenting. Dissection occurred more frequently in emergency procedures and under local anesthesia. Dissection was consistently more frequent with flow diverters, angioplasty/stenting, and lesions requiring balloon dilation or stent deployment, including high-grade stenosis, total occlusion, and atherothrombotic occlusion. In multivariable models, an independent association with mRS 5-6 was observed only in aneurysm treatment (adjusted OR, 2.48; 95% CI, 1.05-5.40). Among 296 isolated dissections, no mRS decline occurred in 265 (89.5%). Decline was more frequent with secondary hemorrhage or infarction than without (26/57 [46%] vs 5/239 [2.1%]; P < .001). At intracranial treatment sites, decline was more frequent with hemorrhage than with infarction (16/25 vs 8/25; P = .047), and death occurred only after hemorrhage (6/25 vs 0/25; P = .02).
Iatrogenic vessel dissection incidence varied substantially across neuroendovascular procedures and was most consistently associated with procedures and lesions requiring balloon dilation or stent deployment. Most dissections did not lead to clinical deterioration; early clinical impact was associated mainly with secondary intracranial hemorrhage or infarction rather than with the dissection itself.

PMID:
42692783
Bibliographic data and abstract were imported from PubMed on 04 Sep 2026.

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