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2017 ; 19
(2
): 131-142
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Causes and Solutions of Endovascular Treatment Failure
#MMPMID28592777
Kim BM
J Stroke
2017[May]; 19
(2
): 131-142
PMID28592777
show ga
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.