I failed, #Tici0...

Recently, I was confronted with an LVO case, an M1 occlusion, in a patient of around 50 who was referred from a peripheral center. When the patient arrived, we were ready and confident… and yet, 2 hours later, we had failed to reopen the target vessel and obviously the outcome was going to be bad.

The recent advent of mechanical thrombectomy (MT) is somehow very similar to the revolution ushered in by antibiotics in the 1950’s­. Most bacterial diseases are now curable, and stroke would soon become like this – an unfortunate, but treatable occurrence.

However, clinical studies still report a 10-20% MT failure rate, and the early days of MT – when each success was an astonishing achievement – are now almost ten years behind us. Good outcomes were to be followed by good outcomes, and an unsuccessful procedure, or even worse, a failure, can now have a deep and durable negative psychological impact on physicians.

Failure teaches us that success is never guaranteed.

The night following my case, I didn’t sleep well. In my mind, I couldn’t stop going around in circles about what we could have done better. Nowadays, there are so many strategies and devices available to perform an MT and Monday-morning quarterbacks will always have a nice bailout option to recommend. But “Time will always be Brain” and a late recanalization can very soon become a futile recanalization.

What it comes down to, especially in these challenging procedures, is that organized research and industrial innovations are still very much needed to assist physicians in reaching success.

With the first heart transplant in 1967, medicine became a very powerful science. In cases of an organ failure, the organ could now simply be replaced, and with this knowledge, appeared a feeling that death itself could become a preventable event.¹ In my own case, I couldn’t stop myself from thinking “We could have saved this 50-year-old patient from disability, if only…”

The expression of our failures as medical doctors is a notoriously taboo subject and talking about it on social media is no exception to this unspoken rule. In an article, #Fake news: a systematic review of MT results among stroke surgeons on Twitter, Dmytriw found much higher reperfusion scores were being reported than in real-life trials (Tici 2c/3 94% vs 71%, respectively; p<0.0001), and all this success without a single complication being reported!

But failure should be our teacher, not our undertaker. Failure is a delay, not a defeat.²

In this first newsletter, we will reflect on problematic occlusions and how we can anticipate such situations.
The second newsletter in this series will focus on preclinical research — the reproduction of tough clots and how industry is developing innovative solutions to address them.
In the final edition of the newsletter, we will provide what’s most important for us as physicians, and in the end, what’s the clinical evaluation of these innovative tools.

_{References:
1. Les soignants et la mort, Florent Schepens
2. Denis Waitley}

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