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Failed mechanical thrombectomy: prevalence, etiology, and predictors
Orgest Lajthia1, Eyad Almallouhi1, Hamid Ali2
1Departments of1Neurosurgery.
Journal of Neurosurgery
|January 21, 2023
Summary
Mechanical thrombectomy (MT) fails in 12% of stroke patients, often due to intracranial atherosclerosis (ICAS). Diabetes mellitus is linked to unsuccessful reperfusion, highlighting the need for better ICAS treatment strategies.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Mechanical thrombectomy (MT) is a key treatment for acute ischemic stroke.
- Reperfusion failure occurs in a significant minority of MT procedures, necessitating investigation into its causes.
Purpose of the Study:
- To identify the primary causes and predictors of failed mechanical thrombectomy.
- To analyze outcomes in a contemporary series of MT procedures.
Main Methods:
- A prospectively maintained database of 1010 MT patients (Jan 2013-Aug 2021) was reviewed.
- Failed MT was defined as a modified Thrombolysis in Cerebral Infarction score < 2b.
- Demographic, procedural, etiological, and anatomical data were collected and analyzed.
Main Results:
- Mechanical thrombectomy failed in 11.9% of cases (120/1010).
- Intracranial atherosclerosis (ICAS) was the most common cause of failure (70% of intracranial failures).
- Longer onset-to-puncture and onset-to-groin times were associated with failed MT; diabetes mellitus was an independent predictor of failure.
Conclusions:
- Failed MT occurred in 11.9% of procedures, primarily due to ICAS.
- Further research is needed to improve the early identification and treatment of ICAS-related large-vessel occlusions.
- Diabetes mellitus is a significant predictor of unsuccessful reperfusion.
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