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Abstract - Original Article

J Cerebrovasc Endovasc Neurosurg. 2023 25(1): 13-18
The Journal of Cerebrovascular and Endovascular Neurosurgery
      
 
Analysis of failed mechanical thrombectomy with a focus on technical reasons: Ten years of experience in a single institution
Sinho Park1, Dong Hoon Lee2, Jae Hoon Sung2, Seung Yoon Song2
1Department of Neurosurgery, Cheongju St Marys Hospital, Cheongju, Korea 2Department of Neurosurgery, St. Vincents Hospital, The Catholic University of Korea, Suwon, Korea

Objective: Mechanical thrombectomy (MT) is an effective treatment for patients suffering from acute ischemic stroke secondary to large vessel occlusion. However, recanalization failure rates of interventions were about 20% in literature studies. We report our experience of unsuccessful MT with a focus on technical reasons. Methods: From December 2010 to June 2021, six hundred eight patients with acute ischemic stroke due to large artery occlusion received MT using a stent retriever with or without an aspiration catheter in our institution. We divided the reasons for failure into six categories. We analyzed the reasons for failure by dividing our experience time into 3 periods. Results: A total of 608 cases of thrombectomy for large vessel occlusion were identified in the study period. The successful recanalization rate was 90.4%. In most of the cases (20/57, 35%), the thrombus persisted despite several passes, and the second most common cause was termination of the procedure even after partial recanalization (10/57, 18%). Similar proportions of in-stent occlusion, distal embolization, and termination due to vessel rupture were observed. On analysis of three periods, the successful recanalization rate improved over time. Conclusions: MT fails due to various reasons, and intracranial artery stenosis is the main cause of MT failure. With the development of rescue techniques, the failure rate has gradually decreased. Further development of new devices and techniques could improve the recanalization rates.
 
Key words : Failed mechanical thrombectomy
 
 
    
 
 
 

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