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Updated: Aug 13, 2025

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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
PubMed
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.

Keywords:
ADAPTICASatherosclerosisendovascular neurosurgerymechanical thrombectomy failurerescue stentingstent retriever

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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.