Abstract
While a stentriever thrombectomy is 70–75% successful in achieving recanalization (modified thrombolysis in cerebral ischemia [mTICI] 2b-3) of an anterior circulation intracranial large artery occlusion (ILAO), 25–30% of ILAOs remain refractory to a stentriever thrombectomy [1, 2]. The etiology of an acute ILAO can play a key role in the response to a stentriever; plus certain complications, such as inadvertent detachment, the stentriever getting stuck, and repeated reocclusion, have also been reported in relation to stroke etiology [3–8]. Therefore, this chapter discusses the pathomechanism of refractoriness to a stentriever, along with suggested solutions.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Goyal M, Menon BK, va Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomized trial. Lancet. 2016;387:1723–31.
Campbell BCV, Donnan GA, Lees KR, et al. Endovascular stent thrombectomy: the new standard of care for large vessel ischaemic stroke. Lancet Neurol. 2015;14:846–54.
Suh HI, Hong JM, Lee KS, Han M, Choi JW, Kim SJ, et al. Imaging predictors for atherosclerosis-related intracranial large artery occlusions in acute anterior circulation stroke. J Stroke. 2016;352–54.
Matias-Guiu JA, Serna-Candel C, Matias-Guiu J. Stroke etiology determines effectiveness of retrievable stents. J Neurointerv Surg. 2014;6:e11.
Toyoda K, Koga M, Hayakawa M, Yamagami H. Acute reperfusion therapy and stroke care in Asia after successful endovascular trials. Stroke. 2015;46:1474–81.
Gascou G, Lobotesis K, Machi P, et al. Stent retrievers in acute ischemic stroke: complications and failures during the perioperative period. AJNR Am J Neuroradiol. 2014;35:734–40.
Kang DH, Kim YW, Hwang YH, Park SP, Kim YS, Baik SK. Instant reocclusion following mechanical thrombectomy of in situ thromboocclusion and the role of low-dose intra-arterial tirofiban. Cerebrovasc Dis. 2014;37:350–5.
Baek JH, Kim BM, Kim DJ, et al. Importance of truncal-type occlusion in stentriever-based thrombectomy for acute stroke. Neurology. 2016;87(15):1542–50. [Epub ahead of print].
Okawa M, Tateshima S, Lieveskind D, et al. Early loss of immediate reperfusion while stent retriever in place predicts successful final reperfusion in acute ischemic stroke patients. Stroke. 2015;46:3266–9.
Yoon W, Kim SK, Park MS, et al. Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke. Neurosurgery. 2015;76:680–6.
Lee JS, Hong JM, Lee KS, et al. Endovascular therapy of cerebral arterial occlusions: intracranial atherosclerosis versus embolism. J Stroke Cerebrovasc Dis. 2015;24:2074–80.
Singh P, Doostkam S, Reinhard M, et al. Immunohistochemical analysis of thrombi retrieved during treatment of acute ischemic stroke: does stent-retriever cause intimal damage? Stroke. 2013;44:1720–2.
Qureshi AI, Siddiqui AM, Kim SH, et al. Reocclusion of recanalized arteries during intra-arterial thrombolysis for acute ischemic stroke. AJNR Am J Neuroradiol. 2004;25:322–8.
Baek JH, Kim BM, Kim DJ, et al. Stenting as a rescue treatment after failure of mechanical thrombectomy for anterior circulation large artery occlusion. Stroke. 2016;47:2360–3.
Levy EI, Mehta R, Gupta R, et al. Self-expanding stents for recanalization of acute cerebrovascular occlusion. AJNR Am J Neuroradiol. 2007;28:816–22.
Zaidat OO, Wolfe T, Hussain SI, et al. Interventional acute ischemic stroke therapy with intracranial self-expanding stent. Stroke. 2008;39:2393–5.
Brekenfeld C, Schroth G, Mattle H, et al. Stent placement in acute cerebral artery occlusion: use of a self-expandable intracranial stent for acute stroke treatment. Stroke. 2009;40:847–52.
Levy EI, Siddiqui AH, Crumlish A, et al. First food and drug administration-approved prospective trial of primary intracranial stenting for acute stroke. Stroke. 2009;40:3552–356.
Suh SH, Kim BM, Roh HG, et al. Self-expanding stent for recanalization of acute embolic or dissecting intracranial artery occlusion. AJNR Am J Neuroradiol. 2010;31:459–63.
Mocco J, Hanel RA, Sharma J, et al. Use of a vascular reconstruction device to salvage acute ischemia occlusions refractory to traditional endovascular recanalization methods. J Neurosurg. 2010;112:557–62.
Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007;38:967–73.
Kim DJ, Kim BM, Suh SH, et al. Self-expanding stent placement for anterior circulation intracranial artery dissection presenting with ischemic symptoms. Neurosurgery. 2015;76:158–64.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer Science+Business Media Singapore
About this chapter
Cite this chapter
Kim, B.M. (2017). Refractory Occlusion to Stentriever Thrombectomy: Etiological Considerations and Suggested Solutions. In: Park, J. (eds) Acute Ischemic Stroke. Springer, Singapore. https://doi.org/10.1007/978-981-10-0965-5_12
Download citation
DOI: https://doi.org/10.1007/978-981-10-0965-5_12
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-10-0964-8
Online ISBN: 978-981-10-0965-5
eBook Packages: MedicineMedicine (R0)