Reasons for Failed Mechanical Thrombectomy in Posterior Circulation Ischemic Stroke Patients
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ORIGINAL ARTICLE
Reasons for Failed Mechanical Thrombectomy in Posterior Circulation Ischemic Stroke Patients Charlotte S. Weyland1 Silvia Schönenberger2
· Ulf Neuberger1 · Arne Potreck1 · Johannes A. R. Pfaff1 · Martin Bendszus1 · Markus A. Möhlenbruch1
· Simon Nagel2
·
Received: 27 May 2020 / Accepted: 6 August 2020 © The Author(s) 2020
Abstract Background and Purpose To determine reasons for failed recanalization in mechanical thrombectomy (MT) of the posterior circulation. Methods Retrospective single center analysis of reasons for MT failure in the posterior circulation. Failed MTs were categorized according to the reason for procedure failure in failed vascular access, failed passage of the target vessel occlusion and MT failure after passing the occluded target vessel. Patient characteristics were compared between failed and successful MT. Results Patients with failed MT (30/218 patients, 13.8%) were categorized into futile vascular access (13/30, 43.3%), abortive passage of the target vessel occlusion (6/30, 20.0%) and MT failure after passing the vessel occlusion (11/30, 36.7%). In 188/218 (86.2%) successful MTs alternative vascular access, local intra-arterial (i.a.) thrombolysis and emergency stent-assisted PTA prevented 65 MT failures. Patients with failed MT showed a higher NIHSS at discharge, a higher pc-ASPECTS in follow-up imaging, a higher mRS 90 days after stroke onset and a high mortality rate of 77.0% (mRS at 90 days, median (IQR): 6 (6–6) vs. 4 (2–6) for successful MT, p-value < 0.001). Co-morbidities and stroke etiology were not different compared to sufficient recanalization with atherosclerotic disease as the leading stroke etiology in both groups. Conclusion Failure of MT in posterior circulation ischemic stroke patients is associated with a high mortality rate. Reasons for MT failure are diverse with futile vascular access and MT failure after passing the vessel occlusion as the leading causes. Alternative vascular access, local i.a. thrombolysis and stent-assisted PTA can prevent MT failure.
Keywords Rescue strategies · Alternative vascular access · Local thrombolysis · Intracranial stenting · Mortality
Availability of data and material Individual participant data that underlie the results reported in this article (after deidentification) will be available to researchers who provide a methodologically sound proposal. Proposals should be directed to the corresponding author beginning 24 months and ending 48 months following article publication. Charlotte S. Weyland [email protected] Ulf Neuberger [email protected]
Simon Nagel [email protected] Silvia Schönenberger [email protected] Martin Bendszus [email protected] Markus A. Möhlenbruch
[email protected] 1
Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
2
Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 6
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