Risk of mechanical thrombectomy recanalization failure: Intraoperative nuances and the role of intracranial atherosclerotic disease

To present intraoperative observations that when recognized may facilitate the identification of patients at high risk MT recanalization failure. We illustrate 4 cases successful via rescue treatment with balloon angioplasty and/or stenting such were noted. also discuss role intracranial atherosclerotic disease in conducted a retrospective review prospectively maintained database for 450 stroke and identified 122 who underwent failed to achieve recanalization. Operative notes reviewed, nuances discussed amongst neurointerventionalists. Intraoperative suggest failure include resistance microwire advancement, significant microcatheter temporary antegrade flow upon stent retriever (SR) deployment, retrograde SR deployment simultaneous aspiration, restricted expansion (“pinched device”), moderate total impedance removal causing vessel/SR stretch on angiographic roadmap, minimal after ?3 device passes. early recognition considering are noted avoid prolonged procedure times, futile reperfusion, reocclusion post-MT. Intracranial be safe effective this patient subgroup. Stent placement considered depending patient’s antiplatelet status, success, concern hemorrhage. Further studies larger cohorts needed.