Reasons for failed endovascular recanalization attempts in stroke patients

Leischner, Hannes; Flottmann, Fabian; Hanning, Uta; Broocks, Gabriel; Faizy, Tobias D.; Deb‐Chatterji, Milani; Bernhardt, Martina; Brekenfeld, Caspar; Buhk, Jan‐Hendrik; Gellißen, Susanne; Thomalla, Götz; Gerloff, Christian; Fiehler, Jens

doi:10.1136/neurintsurg-2018-014060

Cited by 76 publications

(55 citation statements)

References 21 publications

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“…In 20% of the failing interventions, the thrombus could not be reached or passed with the device while in 80% recanalization failed due to other reasons. Literature reports similar data [13]. For patients failing due to mechanical reasons, direct carotid puncture or surgical vascular access, which is currently not performed at our center, could be a therapeutic option in certain cases.…”

Section: Discussionsupporting

confidence: 70%

“…Several retrospective investigations concerning failing thrombectomy were published in recent months [13,14]. In our study, we were able to detect success rates of 83.2% at our center.…”

Section: Discussionsupporting

confidence: 53%

“…A major problem when comparing different studies is the heterogeneous definition of success. In particular, a reperfusion result of mTICI 2a is sometimes regarded as success, sometimes as failure [6,13,14,18,19].…”

Section: Discussionmentioning

confidence: 99%

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Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

et al. 2020

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Purpose Mechanical thrombectomy (MT) is an effective treatment for patients suffering from acute ischemic stroke. However, recanalization fails in about 16.5% of interventions. We report our experience with unsuccessful MT and analyze technical reasons plus patient-related parameters for failure. Methods Five hundred ninety-six patients with acute ischemic stroke in the anterior circulation and intention to perform MT with an aspiration catheter and/or stent retriever were analyzed. Failure was defined as 0, 1, or 2a on the mTICI scale. Patients with failing MT were analyzed for interventional progress and compared to patients with successful intervention, whereby parameters included demographics, medical history, stroke presentation, and treatment.Results One hundred of the 596 (16.8%) interventions failed. In 20 cases, thrombus could not be accessed or passed with the device. Peripheral arterial occlusive disease is common in those patients. In 80 patients, true stent retriever failure occurred. In this group, coagulation disorders are associated with poor results, whereas atrial fibrillation is associated with success.The administration of intravenous thrombolysis and intake of nitric oxide donors are associated with recanalization success. Intervention duration was significantly longer in the failing group. Conclusion In 20% of failing MT, thrombus cannot be reached/passed. Direct carotid puncture or surgical arterial access could be considered in these cases.In 80% of failing interventions, thrombus can be passed with the device, but the occluded vessel cannot be recanalized. Rescue techniques can be an option. Development of new devices and techniques is necessary to improve recanalization rates. Assessment of pre-existing illness could sensitize for occurring complications.

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Section: Discussionsupporting

confidence: 70%

“…Several retrospective investigations concerning failing thrombectomy were published in recent months [13,14]. In our study, we were able to detect success rates of 83.2% at our center.…”

Section: Discussionsupporting

confidence: 53%

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Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

et al. 2020

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“…Reasons for reperfusion failure have been investigated in single center studies on a procedural level (e.g. analyzing anatomical and technical difficulties) and have been classified into technical obstacles in reaching the occlusion site vs. failure to remove the clot [3,4]. Furthermore, EVT failure has been found to be associated with advanced patient age and distal occlusions [4].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Failure of Reperfusion in Endovascular Therapy for Acute Ischemic Stroke

Flottmann

Broocks²,

Faizy

et al. 2020

Clin Neuroradiol

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Aim In acute large vessel occlusions, endovascular therapy (EVT) achieves flow restoration in the majority of cases; however, EVT fails to achieve sufficient reperfusion in a substantial minority of patients. This study aimed to identify predictors of failed reperfusion. Methods In this study 2211 patients from the German Stroke Registry who received EVT for anterior circulation stroke were retrospectively analyzed. Failure of reperfusion was defined as thrombolysis in cerebral infarction (TICI) grades 0/1/2a, and sufficient reperfusion as TICI 2b/3. In 1629 patients with complete datasets, associations between failure of reperfusion and baseline clinical data, comorbidities, location of occlusion, and procedural data were assessed with multiple logistic regression. Results Failure of reperfusion occurred in 371 patients (16.8%) and was associated with the following locations of occlusion: cervical internal carotid artery (ICA, adjusted odds ratio, OR 2.01, 95% confidence interval, CI 1.08-3.69), intracranial ICA without carotid T occlusion (adjusted OR 1.79, 95% CI 1.05-2.98), and M2 segment (adjusted OR 1.86, 95% CI 1.21-2.84). Failed reperfusion was also associated with cervical ICA stenosis (>70% stenosis, adjusted OR 2.90, 95% CI 1.69-4.97), stroke of other determined etiology by TOAST (Trial of ORG 10172 in acute stroke treatment) criteria (e.g. nonatherosclerotic vasculopathies, adjusted OR 2.73, 95% CI 1.36-5.39), and treatment given outside the usual working hours (adjusted OR 1.41, 95% CI 1.07-1.86). Successful reperfusion was associated with higher Alberta stroke program early CT score (ASPECTS) on initial imaging (adjusted OR 0.85, 95% CI 0.79-0.92), treatment with the patient under general anesthesia (adjusted OR 0.72, 95% CI 0.54-0.96), and concomitant ICA stenting in patients with ICA stenosis (adjusted OR 0.20,). The authors Hannes Leischner and Caspar Brekenfeld contributed equally to the manuscript. Electronic supplementary material The online version of this article (https://doi.F. Flottmann et al. ConclusionSeveral factors are associated with failure of reperfusion, most notably occlusions of the proximal ICA and low ASPECTS on admission. Conversely, stent placement in the proximal ICA was associated with reperfusion success.

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“…Despite the proven efficacy of MT, treatment fails in a small subset of patients (approximately 10%) 3. Leischner and coauthors examined this cohort, to determine the technical and anatomic factors that precluded successful recanalization.…”

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confidence: 99%

Better is Good

Albuquerque

2019

J NeuroIntervent Surg

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Reasons for failed endovascular recanalization attempts in stroke patients

Cited by 76 publications

References 21 publications

Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

Factors Associated with Failure of Reperfusion in Endovascular Therapy for Acute Ischemic Stroke

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