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Ischemic stroke
Original research
Mechanical thrombectomy failure in anterior circulation large vessel occlusion: an overview from the ROSSETTI registry
  1. Lluis Morales-Caba1,
  2. Josep Puig2,
  3. Juan Manuel Sanchís3,
  4. Víctor Vázquez4,
  5. Mariano Werner5,
  6. Guillem Dolz6,
  7. Marc Comas-Cufí7,
  8. Pepus Daunis-i-Estadella7,
  9. Pedro Vega8,
  10. Eduardo Murias8,
  11. Eva González9,
  12. Xabier Manso9,
  13. Fernando Delgado10,
  14. Carlos Martínez11,
  15. Carlos Pérez-García12,
  16. Santiago Rosati13,
  17. Sebastian Remollo14,15,
  18. Carlos Castaño16,
  19. Isabel Vielba-Gómez17,
  20. Tomàs Xuclà17,
  21. Lucia Aja18,
  22. Javier Martínez-Fernández19,
  23. Yeray Aguilar Tejedor20,
  24. Jose Carlos Mendez21,
  25. José Carlos Rayón-Aledo22,
  26. Guillermo Parrilla23,
  27. Víctor Cuba24,25,
  28. Luis Hernán Vargas26,
  29. Antonio Doncel-Moriano Cubero27,
  30. Luis San Roman6,
  31. Jordi Blasco6,
  32. Fernando Aparici-Robles28
  1. 1Interventional Neurorradiology, La Fe University and Polytechnic Hospital, Valencia, Spain
  2. 2Radiology Department CDI and IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Spain
  3. 3Neuroradiology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
  4. 4La Fe University and Polytechnic Hospital, Valencia, Spain
  5. 5Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
  6. 6Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Spain
  7. 7Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
  8. 8Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain
  9. 9Interventional Neuroradiology. Radiology, Hospital Universitario Cruces, Bilbao, Spain
  10. 10Diagnostic and Therapeutical Neuroradiology Unit, Hospital Reina Sofía, Córdoba, Spain
  11. 11Neurorradiology, Hospital Universitario Reina Sofia, Cordoba, Spain
  12. 12Interventional Neuroradiology, Hospital Clinico Universitario San Carlos, Madrid, Spain
  13. 13Department of Radiology, Clinical San Carlos Hospital, Section of Interventional Neuroradiology, Madrid, Spain
  14. 14Interventional Neuroradiology Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
  15. 15Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
  16. 16Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
  17. 17Stroke Unit, Department of Neurology, Hospital Universitario de Girona Doctor Josep Trueta, Girona, Spain
  18. 18Neuroradiology, Hospital Universitari de Bellvitge, Barcelona, Spain
  19. 19Department of Radiology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
  20. 20Radiology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
  21. 21Interventional Neuroradiology Unit, Radiology, Hospital Ramón y Cajal, Madrid, Spain
  22. 22Interventional Neuroradiology, Alicante General University Hospital, Alicante, Valenciana, Spain
  23. 23Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
  24. 24Radiology, Bellvitge University Hospital, Barcelona, Spain
  25. 25Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
  26. 26Department of Interventional Neuroradiology, Hospital Universitario de Salamanca, Salamanca, Spain
  27. 27Stroke Unit, Neurology, Hospital Clinic de Barcelona, Barcelona, Spain
  28. 28Sección Neurorradiología, Area Clinica, Imagen Médica, Hospital Politécnico y Universitario La Fe, Valencia, Spain
  1. Correspondence to Dr Josep Puig; jpuigmd{at}gmail.com

Abstract

Background Although mechanical thrombectomy (MT) is an effective treatment for large vessel occlusion (LVO) with a high successful recanalization rate, MT failure (MTF) occurs in 10–15% of cases and is associated with unfavorable outcomes. However, little is known about the clinical, technical, and radiological reasons for MTF. We investigated the technical factors associated with MTF.

Methods We conducted a retrospective analysis of consecutive patients with anterior LVO prospectively included in the ongoing observational multicenter ROSSETTI registry. Patients were categorized according to the success (≥mTICI 2b) or failure (<mTICI 2b) of the MT procedure. Baseline clinical and demographic characteristics, endovascular MT techniques, and angiographic and clinical outcomes were compared. Multivariate analysis for prediction of MTF was performed.

Results We analyzed 4135 patients, including 325 patients (7.9%) with MTF. Patients in the MTF group had a significantly lower Alberta Stroke Program Early CT Score (ASPECTS) at baseline (8 (7–10) vs 9 (8–10)), longer time since last time seen well (279 min vs 262 min), increased MT procedure time (76 min vs 31 min), higher rate of complications (23% vs 4%), higher symptomatic intracerebral hemorrhage (21% vs 7.9%), higher 24 hour National Institutes of Health Stroke Scale score (19 vs 6), worse functional outcome at 3 months (modified Rankin Scale score 0–2, 15.6% vs 53%), and higher mortality (45% vs 20%). Four or more passes were an independent predictor of MTF (OR 3.46, 95% CI 2.58 to 4.63; P<0.001). None of the endovascular techniques demonstrated a higher likelihood of MTF.

Conclusion In this study, MTF in anterior circulation LVO was associated with a high complication rate and worse outcomes.

  • Brain
  • Device
  • Intervention
  • Stroke
  • Technique

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

https://doi.org/10.1136/jnis-2025-023078

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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    Footnotes

    • X @pedrovegavaldes, @emuriass, @Sremollo, @.

    • Contributors LM, JP, and FA-R conceived the original idea. LM, JP, JMS, VV, MW, GDAB, and PV contributed to the design and implementation of the research. JP, MC-C, PD-i-E, EM, EG, XM, FD, CM, CP-G, SRo, SRe, CC, IV-G, TX, LA, JM-F, YAT, JCM, JCR-A, GP, VC, LHV, AD-MC, LSR, JB, and FA-R contributed to the analysis of the results. JP and LM contributed to the writing of the manuscript. All authors discussed the results and contributed to the final manuscript. JB is the guarantor of the study (principal investigator of the ROSSETTI registry).

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.