Evidence map›Paper›PMID 41815305›Full record

ReviewStroke (Hoboken, N.J.)2026

Mastering the Maze: A Narrative Guide on Advanced Tips and Tricks for the Management of Complex Thrombectomy.

Benjamin Maïer, Solène Hébert, Simon Escalard, Hocine Redjem, Jean-Philippe Desilles, William Boisseau, Erwan Robichon, Amira Al Raaisi, Samuel J Mouyal, Arthur Gutter and 5 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Stroke (Hoboken, N.J.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Benjamin MaïerInterventional Neuroradiology Department (B.M., S.H., S.E., H.R., J.-P.D., W.B., E.R., A.A.R., S.J.M., A.G., S.S., R.B., M.P., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.ORCID https://orcid.org/0000-0003-3993-1024
Solène HébertInterventional Neuroradiology Department (B.M., S.H., S.E., H.R., J.-P.D., W.B., E.R., A.A.R., S.J.M., A.G., S.S., R.B., M.P., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.
Simon EscalardInterventional Neuroradiology Department (B.M., S.H., S.E., H.R., J.-P.D., W.B., E.R., A.A.R., S.J.M., A.G., S.S., R.B., M.P., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.ORCID https://orcid.org/0000-0003-1306-1008
Hocine RedjemInterventional Neuroradiology Department (B.M., S.H., S.E., H.R., J.-P.D., W.B., E.R., A.A.R., S.J.M., A.G., S.S., R.B., M.P., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.
Jean-Philippe DesillesInterventional Neuroradiology Department (B.M., S.H., S.E., H.R., J.-P.D., W.B., E.R., A.A.R., S.J.M., A.G., S.S., R.B., M.P., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.ORCID https://orcid.org/0000-0001-8395-6312
William BoisseauInterventional Neuroradiology Department (B.M., S.H., S.E., H.R., J.-P.D., W.B., E.R., A.A.R., S.J.M., A.G., S.S., R.B., M.P., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.ORCID https://orcid.org/0000-0001-8120-5128
Erwan RobichonInterventional Neuroradiology Department (B.M., S.H., S.E., H.R., J.-P.D., W.B., E.R., A.A.R., S.J.M., A.G., S.S., R.B., M.P., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.
Amira Al RaaisiInterventional Neuroradiology Department (B.M., S.H., S.E., H.R., J.-P.D., W.B., E.R., A.A.R., S.J.M., A.G., S.S., R.B., M.P., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.ORCID https://orcid.org/0000-0001-7985-4962
Samuel J MouyalInterventional Neuroradiology Department (B.M., S.H., S.E., H.R., J.-P.D., W.B., E.R., A.A.R., S.J.M., A.G., S.S., R.B., M.P., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.
Arthur GutterInterventional Neuroradiology Department (B.M., S.H., S.E., H.R., J.-P.D., W.B., E.R., A.A.R., S.J.M., A.G., S.S., R.B., M.P., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.
François DelvoyeBiological Resource Center (J.-P.D., F.D., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.ORCID https://orcid.org/0000-0002-0697-2156
Stanislas SmajdaInterventional Neuroradiology Department (B.M., S.H., S.E., H.R., J.-P.D., W.B., E.R., A.A.R., S.J.M., A.G., S.S., R.B., M.P., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.ORCID https://orcid.org/0000-0002-6486-1710
Raphaël BlancInterventional Neuroradiology Department (B.M., S.H., S.E., H.R., J.-P.D., W.B., E.R., A.A.R., S.J.M., A.G., S.S., R.B., M.P., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.ORCID https://orcid.org/0000-0002-3975-3865
Michel PiotinInterventional Neuroradiology Department (B.M., S.H., S.E., H.R., J.-P.D., W.B., E.R., A.A.R., S.J.M., A.G., S.S., R.B., M.P., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.ORCID https://orcid.org/0000-0002-1354-4328
Mikael MazighiInterventional Neuroradiology Department (B.M., S.H., S.E., H.R., J.-P.D., W.B., E.R., A.A.R., S.J.M., A.G., S.S., R.B., M.P., M.M.), Hôpital Fondation A. de Rothschild, Paris, France.ORCID https://orcid.org/0000-0003-0911-8999

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Endovascular therapy has revolutionized the treatment of acute ischemic stroke with large vessel occlusion, becoming the standard of care across anterior and posterior circulation. With expanding indications, including large infarct cores, extended time windows, and older patients, the number and complexity of procedures are steadily increasing worldwide. Although overall rates of successful reperfusion approach 90%, the remaining 10% of failed endovascular therapy highlight the technical challenges still confronting interventionalists. Procedural failure may occur at multiple stages, from arterial puncture to supra-aortic catheterization, intracranial navigation, or closure, each requiring tailored strategies. This review gathers advanced tips and tricks to manage demanding situations, reflecting both published evidence and the long-standing oral transmission that often occurs during fellowships. Practical solutions are described for frequent challenges, including complex femoral access and closure, tortuous supra-aortic vessels, difficult carotid siphons, and hostile intracranial anatomy. Techniques such as buddy-wire, balloon anchoring, stent-anchoring, balloon tracking, direct carotid puncture, and the flossing technique are detailed, alongside structured escalation strategies. Beyond technical skills, this review emphasizes the importance of comprehensive training. Mastery of complex diagnostic cerebral angiographies, supported by simulation-based learning, is considered more relevant than procedural counts to determine readiness for on-call independence. Ultimately, competence is defined not by the number of endovascular therapies performed, but by the ability to anticipate and safely manage complications in unpredictable anatomic settings. Future training should integrate procedural volume, case complexity, and simulation to prepare the next generation of interventionalists to perform endovascular therapy and navigate the unexpected with safety and confidence.

Indexed as

cathetersendovascular proceduresischemic strokestentsthrombectomy

Identifiers

PMID41815305
PMCPMC12959427

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.