“Tough clots" special feature: how to deal with challenging situations and MT failures?



Dr. Jildaz Caroff
Interventional Neuroradiologist
Bicêtre Hospital
Paris, France


“I failed, #Tici0...”

Recently, I was confronted with an LVO case, an M1 occlusion, in a patient of around 50 who was referred by 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...





Reasons for reperfusion failures in stent-retriever-based thombectomy   

There are many potential causes of failure when using a strent-retriever, Dr. Pasquale Mordasini presents their relative prevalence and discuss possible solutions. 

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How to deal with a tough clot?

The proportion of fibrin relative to the red blood cells in a thrombus determines its physical properties and how it responds to thrombectomy, Dr. Paul Bhogal discusses its impact on successrates. 

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Weapon of choice

Dr. Jonathan Cortese reviewed the literature searching for evidence regarding the potential superiority of any mechanical thrombectomy strategy in different clinical situations.

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The toughest clot of all

Cerebral calcified emboli might be the most challenging clots to retrieve, Prof. Frédéric Clarençon discusses angiographic and clinical outcomes in this rare clinical occurrence.

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Clinical outcomes in cases of failure

From the ETIS French registry, Dr. Gaultier Marnat analysed the impact of unsuccessful thrombectomy on our patients and the predictors of a good outcome despite failure.

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Clot Summit

In this interview, Dr. Jens Fiehler presents the CLOT Summit which was created to evaluate and develop pathways for enhancing stroke care.

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Your feedback

How do you deal with MT failures? Many of you responded to our survey published a few days ago. Discover now the answers of your peers!

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Share with us

For the next edition of this tough clot special feature, we want to hear from you again! Answer a few questions about your MT strategy.

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