In Which Cases Is Additional Direct Surgery Useful for Mechanical Thrombectomy Failure?

Area of Science:

• Neurology
• Neurosurgery
• Interventional Radiology

Background:

• Mechanical thrombectomy is a standard treatment for large vessel occlusion (LVO) stroke.
• Limited evidence exists for direct surgery following failed mechanical thrombectomy in LVO patients.
• Identifying patients who benefit from additional surgical intervention is crucial.

Purpose of the Study:

• To investigate factors influencing mechanical thrombectomy success in LVO.
• To evaluate the outcomes of patients undergoing direct surgery after failed thrombectomy.
• To determine criteria for selecting patients for additional surgical management.

Main Methods:

• Retrospective analysis of 152 patients with LVO.
• Assessment of factors affecting mechanical thrombectomy success, including the hyperdense artery sign ratio.
• Evaluation of outcomes for patients receiving direct surgery post-thrombectomy failure.
• Analysis included Diffusion-Weighted Imaging-Clinical mismatch and modified Rankin Scale scores.

Main Results:

• Successful recanalization occurred in 82.8% of patients.
• Male gender and a higher hyperdense artery sign ratio (>1.05) were associated with successful recanalization.
• Direct surgery was performed in 6 of 28 patients with thrombectomy failure.
• Patients undergoing direct surgery showed better modified Rankin Scale scores at discharge.

Conclusions:

• The hyperdense artery sign ratio is a predictor of mechanical thrombectomy success.
• A ratio <1.05 suggests frequent thrombectomy failure, indicating potential benefit from early direct surgery.
• Direct surgery may improve outcomes in carefully selected LVO patients after thrombectomy failure.