title: Stentriever Thrombectomy Failure: A Challenge in Stroke Management.
abstract: OBJECTIVE
  Stentriever thrombectomy failure in patients with acute ischemic stroke caused by anterior circulation large artery occlusion is not a rare event. The purpose of this study was to investigate whether other procedures (tirofiban, permanent stenting) are able to recanalize the occluded vessel and determine a better outcome without increasing mortality and intracranial hemorrhage rates.
  
  
  METHODS
  Among 513 patients consecutively admitted with anterior circulation stroke, 109 underwent stentriever thrombectomy. Modified Thrombolysis in Cerebral Ischemia (mTICI) 2b-3 recanalization was achieved in 60 patients (55.0%, group 1). Only 3 of 19 patients (group 2) obtained additional recanalization with intra-arterial infusion of tirofiban. The remaining 46 either underwent permanent stenting (n = 23, group 3) or were left nonrecanalized (n = 23, group 4). The rate of mTICI 2b-3 and clinical outcomes were analyzed in the different groups.
  
  
  RESULTS
  A successful recanalization (mTICI 2b-3) was achieved in 17 patients of group 3 (73.9%). A significantly better outcome was observed in group 3 (modified Rankin Scale [mRS] score, 0-2) than in group 4 at 3 months (56.5% vs. 17.4%). Symptomatic intracranial hemorrhage rates were not different between group 3 and group 4 (4.3% vs. 4.3%), whereas there was a significantly higher mortality in group 4 than in group 3 (39.1% vs. 4.3%). On multivariate analysis, permanent stenting was the only factor independently associated with favorable outcome and mortality.
  
  
  CONCLUSIONS
  Permanent stenting might be a feasible solution in patients with acute large artery occlusion after stentriever thrombectomy failure.
authors.affiliation: Department of Neuroscience, University of Padua School of Medicine, Padua, Italy. Electronic address: claudiobaracchini@gmail.com.
authors.forename: Claudio
authors.initials: C
authors.lastname: Baracchini
authors.affiliation: Department of Neuroscience, University of Padua School of Medicine, Padua, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Farina
authors.affiliation: Department of Neuroscience, University of Padua School of Medicine, Padua, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Soso
authors.affiliation: Department of Neuroscience, University of Padua School of Medicine, Padua, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Viaro
authors.affiliation: Department of Neuroscience, University of Padua School of Medicine, Padua, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Favaretto
authors.affiliation: Department of Neuroscience, University of Padua School of Medicine, Padua, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Palmieri
authors.affiliation: Department of Neuroscience, University of Padua School of Medicine, Padua, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Kulyk
authors.affiliation: Vascular Study Group, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua School of Medicine, Padua, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Ballotta
authors.affiliation: Neuroradiology Unit, University of Padua School of Medicine, Padua, Italy.
authors.forename: Lorena
authors.initials: L
authors.lastname: Nico
authors.affiliation: Neuroradiology Unit, University of Padua School of Medicine, Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Cester
authors.affiliation: Neuroradiology Unit, University of Padua School of Medicine, Padua, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Causin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D002533:Cerebral Angiography; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000628:therapy; D007261:Infusions, Intra-Arterial; D020300:Intracranial Hemorrhages / Q000453:epidemiology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011446:Prospective Studies; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods; D000077466:Tirofiban; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D017211:Treatment Failure; D016896:Treatment Outcome; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D005343:Fibrinolytic Agents; D014443:Tyrosine; D010959:Tissue Plasminogen Activator; D000077466:Tirofiban
keywords: Mechanical thrombectomy; Stent; Stroke; Tirofiban