J Stroke.  2017 May;19(2):131-142. 10.5853/jos.2017.00283.

Causes and Solutions of Endovascular Treatment Failure

• Kim BM

• KMID: 2389201
• DOI: http://doi.org/10.5853/jos.2017.00283

Abstract

In a meta-analysis of individual patient data from 5 randomized controlled trials, endovascular treatment (EVT) mainly using a stent retriever achieved successful recanalization in 71.1% of patients suffering from acute stroke due to anterior circulation large artery occlusion (LAO). However, EVT still failed in 28.9% of LAO cases in those 5 successful trials. Stent retriever failure may occur due to anatomical challenges (e.g., a tortuous arterial tree from the aortic arch to a target occlusion site), a large quantity of clots, tandem occlusion, clot characteristics (fresh versus organized clots), different pathomechanisms (embolic versus non-embolic occlusion), etc. Given that recanalization success is the most important factor in the neurological outcome of acute stroke patients, it is important to seek solutions for such difficult cases. In this review, the basic technique of EVT is briefly summarized and then various difficult cases with diverse conditions are discussed along with suggested solutions.

Keyword

Acute stroke; Endovascular thrombectomy; Stent retriever

MeSH Terms

Aorta, Thoracic
Arteries
Humans
Stents
Stroke
Treatment Failure*
Trees