Log In

Forgot Password?

OR

Not a member? Continue as a nonmember.

Become a Member

By becoming a member of the AAN, you can receive exclusive information to help you at every stage of your career. Benefits include:

Join Now See All Benefits

Loading... please wait

Abstract Details

Failed Mechanical Thrombectomy: prevalence, etiology and predictors
Cerebrovascular Disease and Interventional Neurology
S24 - Cerebrovascular Disease and Interventional Neurology: Endovascular Thrombectomy and Large Vessel Occlusions (1:36 PM-1:48 PM)
004

Despite improved endovascular techniques, advances in catheter and stent retriever technology, and accumulated user experience, mechanical thrombectomy fails to achieve successful revascularization in approximately 20% of patients. 

This study aims to identify the prevalence, common etiologies and predictors of failed thrombectomy in a contemporary series.

A prospectively maintained database of MT patients between January 2013 and August 2021 was interrogated. Failed MT was defined as final reperfusion score mTICI (modified Thrombolysis in Cerebral Infarction) < 2B. We collected demographic data, procedural details, stroke etiology, and anatomic data in patients who underwent MT with subsequent failed reperfusion. 

Of a total 1010 MT procedures, 120 (11.9%) were unsuccessful. Mean age was 66.8 years, 51.5% were male, and 61.1% were Caucasian. The most common failure location was intracranial (93.3%) followed by failure at the arch (3.33%) and neck (3.3%). Among patients who failed intracranially, underlying intracranial arterial stenosis (ICAS) was the cause of failure in 84 patients (70%). Compared to successful MT, failed MT patients had longer onset to puncture (p=0.012) and groin time (p=0.004). Rescue stenting was more common in the successful MT group (12% vs 5.1%, p=0.024). Multivariate analysis demonstrated that Diabetes Mellitus (p = 0.009), > 3 thrombectomy passes (p <0.001), and longer onset to groin time (p = 0.004) were independently associated with unsuccessful recanalization. 

Failed MT is encountered in approximately 12% of MT procedures. The most common cause of failed MT was underlying ICAS. Further studies to evaluate better ways of early identification and treatment of ICAS related LVO are warranted.

Authors/Disclosures
Hamid Ali, MBBS (Medical University of South Carolina)
PRESENTER
Dr. Ali has nothing to disclose.
Orgest Lajthia, MD Dr. Lajthia has nothing to disclose.
Eyad Almallouhi, MD (MUSC) Dr. Almallouhi has nothing to disclose.
Muhammed Amir Essibayi, MD (Albert Einstein College of Medicine) Dr. Essibayi has nothing to disclose.
Eric Bass, DO Dr. Bass has nothing to disclose.
Ron Neyens, Other Dr. Neyens has nothing to disclose.
Mohammad Anadani, MD (Medical University of South Carolina) Dr. Anadani has nothing to disclose.
Reda Mohamad Chalhoub, Other The institution of Mr. Chalhoub has received research support from National Institute for Drug Abuse.
Kimberly Kicielinski Kimberly Kicielinski has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Kimberly Kicielinski has received research support from Penumbra.
Jonathan Lena Jonathan Lena has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker Neurovascular.
Guilherme *use 220506 Porto No disclosure on file
Mithun G. Sattur, MD,MBBS,Other (MUSC) Dr. Sattur has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Penumbra. Dr. Sattur has stock in CLPT.
Alejandro Spiotta Alejandro Spiotta has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Penumbra. Alejandro Spiotta has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for IschemaView. Alejandro Spiotta has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Terumo. Alejandro Spiotta has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Stryker. The institution of Alejandro Spiotta has received research support from Penumbra. The institution of Alejandro Spiotta has received research support from Medtronic. The institution of Alejandro Spiotta has received research support from Stryker.
Sami Alkasab, MD (University of Iowa) No disclosure on file