Stentriever Thrombectomy Failure: A Challenge in Stroke Management.

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Surgery

Background:

• Stentriever thrombectomy failure occurs in acute ischemic stroke due to large artery occlusion.
• Alternative recanalization strategies are needed to improve patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of tirofiban and permanent stenting in achieving recanalization after failed stentriever thrombectomy.
• To determine if these procedures improve clinical outcomes without increasing mortality or intracranial hemorrhage.

Main Methods:

• Retrospective analysis of 513 anterior circulation stroke patients, with 109 undergoing stentriever thrombectomy.
• Patients were grouped based on recanalization success (mTICI 2b-3), additional tirofiban use, permanent stenting, or no recanalization.
• Clinical outcomes, including modified Rankin Scale (mRS) scores, mortality, and intracranial hemorrhage, were analyzed.

Main Results:

• Permanent stenting achieved successful recanalization (mTICI 2b-3) in 73.9% of patients.
• Patients undergoing permanent stenting showed significantly better 3-month outcomes (mRS 0-2) compared to non-recanalized patients (56.5% vs. 17.4%).
• Permanent stenting was associated with significantly lower mortality (4.3% vs. 39.1%) and similar symptomatic intracranial hemorrhage rates.

Conclusions:

• Permanent stenting is a feasible and effective strategy for patients with acute large artery occlusion following stentriever thrombectomy failure.
• This approach improves functional outcomes and reduces mortality in selected stroke patients.