Table 2

Summary of technical details of thrombectomy, rescue approaches and outcomes

PtOcclusion siteIV rtPA before; IV heparin during thrombectomyGeneral anesthesia, yes/noApproach to thrombectomyStent retriever, No of passesLocation of perforationSuspected cause of perforationRescue endovascular treatmentRescue surgical treatmentPostprocedure CTOutcomes
1MCA M1, ACA A2IV rtPAYesBGC+stent retrieverSolitaire 4×40, MCA—1 pass, ACA—1 passACA A2Vessel tortuosity and intracranial atheroFlow arrest with BGCEVDSAH, IVHTICI 3; death in hospital
2MCA M2IV rtPANoBGC+stent retrieverTrevo 4×20, 2 passesMCA M2Vessel tortuosity; perforation when traversing clotInflation of intracranial balloonNoneSAHTICI 2a, mRS 2 at 3 months
3MCA M1IV rtPANoBGC+stent retrieverSolitaire 4×20, 2 passesMCA M2/3Perforation when traversing clot, loss of feedback from microcatheterContrast extravasation was self-limiting, thrombectomy continued with additional 2 passes of stent retrieverNoneSAHTICI 2b; mRS 0 at 3 months
4PCA P1NoneNoBGC+stent retrieverNAPCA P2/3Perforation with microwire/microcather when traversing clotProcedure abortedNoneSAHTICI 0, death in hospital
5ICA-TIV heparinYesStent retriever+distal aspirationSolitaire 4×20, 1 passMCA M1Hard clot, resistance when withdrawing stent retrieverHeparin reversal, intracranial balloon inflation (unsuccessful)→ occlusion of MCA with coilsNoneSAH, IVH, IPHTICI 0; death in hospital
6MCA M2IV rtPA, IV heparinNoStent retrieverSolitaire 4×20, 1 passMCA M2Hard clot and intracranial athero, entrapment of stent retriever during withdrawalHeparin reversal, intracranial balloon inflationNoneSAH, IVHTICI 2a; mRS 1 at 3 months
7ICA-TIV rtPA, IV heparinNoADAPT→stent retriever under distal aspirationSolitaire 4×20, 1 passICA-TResistance when withdrawing stent retrieverHeparin reversal, procedure abortedNoneSAH, IVH, herniationTICI 0, death in hospital
8MCA M2NoneYesADAPT→stent retriever+distal aspirationTrevo 3×20, 2 passesMCA M2Hard clotReversal of elevated INR, procedure abortedNoneSAHTICI 2a, mRS 5 at 3 months
9MCA M1NoneNoStent retriever+distal aspirationTrevo 3×20, 2 passesMCA M2Unremarkable thrombectomyIntracranial balloon inflationComfort measuresSAHTICI 2a, mRS 6 at 3 months
10MCA M1NoneNoStent retriever+distal aspirationSolitaire 6×20, 1 passMCA M1Unremarkable thrombectomy. Possibly with microwire/microcatheter when traversing clotIntracranial balloon inflation (unsuccessful), M1 sacrifice with coilsNoneSAH, IPHTICI 0, death in hospital
11MCA M3IV rtPA, IV heparinYesStent retrieverSolitaire 4×20, 1 passMCA M3Hard clot, significant resistance when traversing with microwireProcedure abortedCraniectomySAH, IPHTICI 2a, mRS 2 at 3 months
12ICA-TNoneNoADAPT→stent retriever for M1/2Trevo 4×30, 1 passMCA M2Resistance withdrawing stent retrieverProcedure abortedNoneSAHTICI 2a, mRS 4 at 3 months
13BANoneYesStent retriever+distal aspirationTrevo 4×20, 2 passesVB junctionResistance withdrawing stent retriever. Calcifications at VB junctionProcedure abortedComfort measures per family wishesSAHTICI 2b, death in hospital
14BANoneYesStent retriever+distal aspirationSolitaire 4×20, did not deployPCA P1Resistance when traversing P1 segment with microcatheter. Suspected “fetal” Pcomm variant rather than P1 occlusionInflation of intracranial balloonEVDSAHTICI 0, death in hospital
15MCA M2NoneNoADAPT→stent retriever+distal aspirationTrevo 3×20, 2 passesMCA M3Resistance withdrawing stent retrieverProcedure abortedNoneSAHTICI 2b, death in hospital
16MCA M1IV rtPANoStent retriever+distal aspirationSolitaire 4×40, 1 passMCA M1Unremarkable thrombectomyInflation of intracranial balloon, cryoprecipitate, aminocaproic acidEVDSAHTICI 0, death in hospital
  • ACA, anterior cerebral artery; ADAPT, a direct aspiration first pass technique; BA, basilar artery; BGC, balloon guide catheter, EVD, external ventricular drain; ICA-T, internal carotid artery terminus; INR, international normalized ratio; IPH, intraparenchymal hemorrhage; IVH, intraventricular hemorrhage; L, left; MCA, middle cerebral artery; mRS, modified Rankin Scale; PCA, posterior cerebral artery; Pcomm, posterior communicating artery; R, right; rtPA, recombinant tissue plasminogen activator; SAH, subarachnoid hemorrhage; TICI, Thrombolysis in Cerebral Infarction; VB, vertebrobasilar.