Division of Neurology, Department of Medicine, National University Health System, 1E Kent Ridge Rd, 119228, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Clin Neuroradiol. 2019 Sep;29(3):401-414. doi: 10.1007/s00062-019-00777-1. Epub 2019 Mar 20.
Thrombectomy is a technique that has completely changed the management of acute stroke and current devices have shown that they can achieve upwards of 90% successful recanalization in selected cohorts. However, despite the effectiveness of these devices, there are a proportion of patients who still fail to achieve reperfusion of the affected vascular territory and an even larger portion of patients who have poor functional outcomes in spite of successful recanalization. There are no guidelines on how to treat these patients when such failures occur. In an effort to understand the underpinnings of how failed thrombectomy occurs, we extensively reviewed the current literature in clot properties, vascular access problems, stroke pathogenic mechanisms, embolic complications, failed procedures and pre-procedural imaging. A short summary of each of these contentious areas are provided and the current state of the art. Together these elements give a cohesive overview of the mechanisms of failed thrombectomy as well as the controversies facing the field. New techniques and devices can then be developed to minimize such factors during stroke thrombectomy.
取栓术是一种彻底改变急性脑卒中治疗方式的技术，目前的设备已经证明，在特定患者人群中可以实现高达 90%的血管再通率。然而，尽管这些设备非常有效，但仍有一部分患者的受累血管区域未能实现再灌注，还有一部分患者尽管血管再通，但功能预后仍较差。对于这些患者，当出现这种失败时，尚无治疗指南。为了了解取栓失败的潜在机制，我们广泛回顾了目前关于血栓特性、血管入路问题、卒中发病机制、栓塞并发症、失败手术和术前影像学的文献。本文对这些有争议的领域进行了简要总结，并介绍了目前的最新技术。这些内容共同概述了取栓失败的机制以及该领域面临的争议。随后可以开发新技术和新设备，以便在卒中取栓术中最大限度地减少这些因素。
