Failed thrombectomy – initially typical looking M1 occlusion with unproductive passes 2021 statement + 2022 update
The technical success of endovascular stroke therapy is one of the most important modifiable predictors of therapy benefit in patients presenting with large-vessel-occlusion acute ischemic stroke. While unsuccessful reperfusion (≤TICI 2a) often results from incomplete retrieval due to distal embolization and/or clot fragmentation (TICI 2a), in some patients, no reperfusion (Thrombolysis In Cerebral Infarction score = TICI 0/1) can be achieved and is called reperfusion failure. This applies to 5%–10% of patients with acute ischemic stroke with an intention to treat with mechanical thrombectomy.
Since the beginning of the procedure, you may introduce Nimodipine or Milrinone i.a. in order to relax the vessel and decrease the friction between the vessel wall and later on used devices.
* If you are convinced that taken strategy will fail also at second attempt, you may reduce the number of passes to only one attempt. As for the aspiration technique, you can also try changing the type of aspiration catheter and the way the catheter adheres to the clot.
* If the procedure takes long or you have already performed many attempts or if you have strong suspicion of underlying intracranial stenosis, it is recommended to load the patient with antithrombotic drug i.v. such as Tirofiban or Integrilin or Cangrelor. This will secure endothelial damage after many passes and stabilize the lesion as well as maintain vessel patency after PTA/stent placement.
You may implement part of the drug through the opened stent-retriever i.a. – this may improve resolution of the thrombus, however be aware of possible increase of the rate of intracranial hemorrhage.
are necessary for technical reasons. Without them, this website may not function properly.
are necessary for specific functionality on the website. Without them, some features may be disabled.
allow us to analyse website use and to improve the visitor's experience.
allow us to personalise your experience and to send you relevant content and offers, on this website and other websites.