Clinical Neuroradiology

, Volume 29, Issue 3, pp 401–414 | Cite as

Why Does Mechanical Thrombectomy in Large Vessel Occlusion Sometimes Fail?

A Review of the Literature
  • Leonard L. L. YeoEmail author
  • Pervinder Bhogal
  • Anil Gopinathan
  • Yang Cunli
  • Benjamin Tan
  • Tommy Andersson
Review Article


Thrombectomy is a technique that has completely changed the management of acute stroke and current devices have shown that they can achieve upwards of 90% successful recanalization in selected cohorts. However, despite the effectiveness of these devices, there are a proportion of patients who still fail to achieve reperfusion of the affected vascular territory and an even larger portion of patients who have poor functional outcomes in spite of successful recanalization. There are no guidelines on how to treat these patients when such failures occur. In an effort to understand the underpinnings of how failed thrombectomy occurs, we extensively reviewed the current literature in clot properties, vascular access problems, stroke pathogenic mechanisms, embolic complications, failed procedures and pre-procedural imaging. A short summary of each of these contentious areas are provided and the current state of the art. Together these elements give a cohesive overview of the mechanisms of failed thrombectomy as well as the controversies facing the field. New techniques and devices can then be developed to minimize such factors during stroke thrombectomy.


Ischemic stroke Clots Acute Unsuccessful causes 



The authors gratefully acknowledge David Vale and Michael Gilvarry of Neuravi/Cerenovus Inc. for the use of figures and videos from their in vitro modeling.

Conflict of interest

L.L.L. Yeo has received substantial grant funding from the National Medical Research Council (NMRC), Singapore, substantial grant funding from the Ministry of Health (MOH), Singapore and a moderate grant funding from I2R, A‑STAR, Singapore. P. Bhogal is consultant for Neurvana Medical and Phenox. T. Andersson is a consultant for Ablynx, Amnis Therapeutics, Medtronic, Neuravi/J&J, Rapid Medical and Stryker. A. Gopinathan, Y. Cunli and B. Tan declare no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Leonard L. L. Yeo
    • 1
    • 2
    Email author
  • Pervinder Bhogal
    • 3
  • Anil Gopinathan
    • 2
    • 4
  • Yang Cunli
    • 2
    • 4
  • Benjamin Tan
    • 1
    • 2
  • Tommy Andersson
    • 5
    • 6
  1. 1.Division of Neurology, Department of MedicineNational University Health SystemSingaporeSingapore
  2. 2.Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  3. 3.Department of NeuroradiologySt. Bartholomew’s and the Royal London HospitalLondonUK
  4. 4.Department of Diagnostic ImagingNational University Health SystemSingaporeSingapore
  5. 5.Department of Clinical Neuroscience, Karolinska Institutet and Department of NeuroradiologyKarolinska University HospitalStockholmSweden
  6. 6.Department of Medical ImagingAZ GroeningeKortrijkBelgium

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