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.

中文翻译：

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后循环缺血性卒中患者机械取栓失败的原因。

背景和目的

确定后循环机械血栓切除术 (MT) 再通失败的原因。

方法

后循环 MT 失败原因的回顾性单中心分析。根据血管通路失败、目标血管闭塞通过失败和通过闭塞目标血管后 MT 失败的手术失败原因对失败的 MT 进行分类。比较了失败和成功的 MT 之间的患者特征。

结果

MT 失败的患者（30/218 例，13.8%）分为无效血管通路（13/30，43.3%）、目标血管闭塞的流产通过（6/30，20.0%）和通过血管后 MT 失败闭塞 (11/30, 36.7%)。在 188/218 (86.2%) 例成功的 MT 替代血管通路中，局部动脉内 (ia) 溶栓和紧急支架辅助 PTA 预防了 65 例 MT 失败。MT 失败的患者出院时 NIHSS 较高，随访成像中 pc-ASPECTS 较高，卒中发作后 90 天 mRS 较高，死亡率高达 77.0%（90 天时的 mRS，中位数（IQR）：6 (6-6) vs. 4 (2-6) 成功的 MT，p-值 < 0.001)。与以动脉粥样硬化疾病为主要卒中病因的充分再通相比，合并症和卒中病因没有差异。

结论

后循环缺血性卒中患者的 MT 失败与高死亡率相关。MT 失败的原因多种多样，血管通路无效和通过血管闭塞后的 MT 失败是主要原因。替代血管通路、局部 ia 溶栓和支架辅助 PTA 可以预防 MT 失败。