• Matthew Webb, Muhammed Amir Essibayi, Sami Al Kasab, Ilko L Maier, Marios-Nikos Psychogios, Jonathan A Grossberg, Ali Alawieh, Stacey Quintero Wolfe, Adam Arthur, Travis Dumont, Peter Kan, Joon-Tae Kim, Reade De Leacy, Joshua Osbun, Ansaar Rai, Pascal Jabbour, Min S Park, Roberto Crosa, Michael R Levitt, Adam Polifka, Shinichi Yoshimura, Charles Matouk, Richard W Williamson, Isabel Fragata, Shakeel A Chowdhry, Robert M Starke, Edgar A Samaniego, Hugo Cuellar, Alejandro Spiotta, and Justin Mascitelli.
• Department of Neurosurgery, University of Texas Health Science Center San Antonio, San Antonio , Texas , USA.
• Neurosurgery. 2023 Nov 1; 93 (5): 116811791168-1179.

BackgroundMechanical thrombectomy failure (MTF) occurs in approximately 15% of cases.ObjectiveTo investigate factors that predict MTF.MethodsThis was a retrospective review of prospectively collected data from the Stroke Thrombectomy and Aneurysm Registry. Patients who underwent mechanical thrombectomy (MT) for large vessel occlusion (LVO) were included. Patients were categorized by mechanical thrombectomy success (MTS) (≥mTICI 2b) or MTF (ResultsA total of 6780 patients were included, and 1001 experienced anterior circulation MTF. Patients in the MTF group were older (73 vs 72, P = .044) and had higher poor premorbid modified Rankin Scale (mRS) (10.8% vs 8.4%, P = .017). Onset to puncture time was greater in the MTF group (273 vs 260 min, P = .08). No significant differences were found between the access site, use of balloon guide catheter, frontline technique, or first-pass devices between the MTF and MTS groups. More complications occurred in the MTF group (14% vs 5.8%), including symptomatic intracerebral hemorrhage (9.4% vs 6.1%) and craniectomies (10% vs 2.8%) ( P < .001). On UVA, age, poor pretreatment mRS, increased number of passes, and increased procedure time were associated with MTF. Internal carotid artery, M1, and M2 occlusions had decreased odds of MTF. Poor preprocedure mRS, number of passes, and procedure time remained significant on MVA. A subgroup analysis of posterior circulation LVO revealed that number of passes and total procedure time correlated with increased odds of MTF ( P < .001) while rescue stenting was associated with less odds of MTF (odds ratio 0.20, 95% CI 0.06-0.63). Number of passes remained significant on MVA of posterior circulation occlusion subgroup analysis.ConclusionAnterior circulation MTF is associated with more complications and worse outcomes. No differences were found between techniques or devises used for the first pass during MT. Rescue intracranial stenting may decrease the likelihood of MTF for posterior circulation MT.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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