Alverne Francisco José Arruda Mont, Lima Fabricio Oliveira, Rocha Felipe de Araújo, Bandeira Diego de Almeida, Lucena Adson Freitas de, Silva Henrique Coelho, Lee Jin Soo, Nogueira Raul Gomes
Interventional Neuroradiology Service, Hospital Geral de Fortaleza, Fortaleza, Brazil.
Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Brazil.
J Stroke. 2020 May;22(2):185-202. doi: 10.5853/jos.2020.00227. Epub 2020 May 31.
The benefit of mechanical thrombectomy (MT) in acute ischemic stroke (AIS) due to large vessel intracranial occlusions is directly related to the technical success of the procedures in achieving fast and complete reperfusion. While a precise definition of refractoriness is lacking in the literature, it may be considered when there is reperfusion failure, long procedural times, or high number of passes with the MT devices. Detailed knowledge about the causes for refractory MT in AIS is limited; however, it is most likely a multifaceted problem including factors related to the vascular anatomy and the underlying nature of the occlusive lesion amongst other factors. We aim to review the impact of several key unfavorable anatomical factors that may be encountered during endovascular AIS treatment and discuss potential bail-out strategies to these challenging situations.
机械取栓术（MT）在治疗因颅内大血管闭塞导致的急性缺血性卒中（AIS）中的益处，直接与该手术在实现快速和完全再灌注方面的技术成功相关。虽然文献中缺乏对难治性的精确定义，但当出现再灌注失败、手术时间长或使用MT设备的通过次数多时，可能会考虑难治性。关于AIS中难治性MT的原因的详细知识有限；然而，这很可能是一个多方面的问题，包括与血管解剖结构以及闭塞病变的潜在性质等其他因素相关的因素。我们旨在综述在血管内AIS治疗过程中可能遇到的几个关键不利解剖因素的影响，并讨论应对这些具有挑战性情况的潜在补救策略。
