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Published on: August 18, 2015
Reasons for Failed Mechanical Thrombectomy in Posterior Circulation Ischemic Stroke Patients
Charlotte S Weyland1, Ulf Neuberger1, Arne Potreck1
1Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Background And Purpose:
To determine reasons for failed recanalization in mechanical thrombectomy (MT) of the posterior circulation.
Methods:
Retrospective single center analysis of reasons for MT failure in the posterior circulation. Failed MTs were categorized according to the reason for procedure failure in failed vascular access, failed passage of the target vessel occlusion and MT failure after passing the occluded target vessel. Patient characteristics were compared between failed and successful MT.
Results:
Patients with failed MT (30/218 patients, 13.8%) were categorized into futile vascular access (13/30, 43.3%), abortive passage of the target vessel occlusion (6/30, 20.0%) and MT failure after passing the vessel occlusion (11/30, 36.7%). In 188/218 (86.2%) successful MTs alternative vascular access, local intra-arterial (i.a.) thrombolysis and emergency stent-assisted PTA prevented 65 MT failures. Patients with failed MT showed a higher NIHSS at discharge, a higher pc-ASPECTS in follow-up imaging, a higher mRS 90 days after stroke onset and a high mortality rate of 77.0% (mRS at 90 days, median (IQR): 6 (6-6) vs. 4 (2-6) for successful MT, p-value < 0.001). Co-morbidities and stroke etiology were not different compared to sufficient recanalization with atherosclerotic disease as the leading stroke etiology in both groups.
Conclusion:
Failure of MT in posterior circulation ischemic stroke patients is associated with a high mortality rate. Reasons for MT failure are diverse with futile vascular access and MT failure after passing the vessel occlusion as the leading causes. Alternative vascular access, local i.a. thrombolysis and stent-assisted PTA can prevent MT failure.
Insights
Mechanical thrombectomy (MT) failure in posterior circulation strokes leads to high mortality. Key reasons include difficult vascular access and issues after passing the occlusion, though alternative techniques can prevent failure.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Surgery
Background:
- Mechanical thrombectomy (MT) is a critical treatment for acute ischemic stroke.
- Posterior circulation strokes present unique challenges for MT.
- Understanding MT failure is crucial for improving patient outcomes.
Purpose of the Study:
- To identify and categorize the reasons for failed recanalization during MT of posterior circulation occlusions.
- To compare patient characteristics between successful and failed MT procedures.
- To determine the impact of MT failure on patient outcomes and mortality.
Main Methods:
- Retrospective single-center analysis of posterior circulation MT procedures.
- Categorization of MT failures into futile vascular access, failed passage, and post-passage failure.
- Comparison of patient demographics, clinical presentation (NIHSS, pc-ASPECTS), and functional outcomes (mRS) between failed and successful MT groups.
Main Results:
- MT failure occurred in 13.8% of posterior circulation cases (30/218).
- Leading causes of failure were futile vascular access (43.3%) and post-passage failure (36.7%).
- Failed MT was associated with significantly higher NIHSS, higher pc-ASPECTS, worse 90-day mRS, and a high mortality rate (77.0%).
Conclusions:
- Failure of MT in posterior circulation ischemic stroke carries a substantial mortality risk.
- Diverse reasons contribute to MT failure, with vascular access and post-passage complications being primary concerns.
- Alternative strategies like different vascular access, intra-arterial thrombolysis, and stent-assisted PTA can mitigate MT failure.
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