2-1-2 Stroke microsurgical thrombectomy technique as a tertiary/salvage treatment option.

Autor:	Oliveira MM; Department of Neurosurgery, Federal University of Minas Gerais, Belo Horizonte, Brazil - mmagaldi@hotmail.com., Avellar L; Department of Neurosurgery, Roberto Santos Hospital, Salvador, Brazil., Malheiros JA; Department of Neurosurgery, Federal University of Minas Gerais, Belo Horizonte, Brazil., Ferrarez CE; Department of Neurosurgery, Federal University of Minas Gerais, Belo Horizonte, Brazil., Lima GM; Department of Neurosurgery, Federal University of Minas Gerais, Belo Horizonte, Brazil., Costa PH; Department of Neurosurgery, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgical sciences [J Neurosurg Sci] 2023 Oct; Vol. 67 (5), pp. 616-622. Date of Electronic Publication: 2022 Feb 11.
DOI:	10.23736/S0390-5616.21.05480-1
Abstrakt:	Background: Microsurgical thrombectomy (MST) has been used for many years in few stroke cases without any prospective randomized study, nor detailed systemized technique description. As many centers worldwide are recruited for stroke thrombectomy availability, MST might increase in the near future either as a tertiary or salvage treatment option. A straightforward surgical plan is mandatory empowering a safe, efficient, and rapid neurosurgical operation, so our aim is to describe the 2-1-2 microsurgical technique. Methods: Three patients presented at emergency department with large stroke not suitable to venous thrombolysis and/or mechanical thrombectomy due to late arrival time and endovascular suite technical problems. They were referred to 2-1-2 MST after imaging showed brain collaterals on head angio-CT scan and ASPECTS greater than 6 points. The procedure comprised 2 insulin needle punctures in the target artery, 1mm micro-scissor transverse arteriotomy, milk thrombus removal and 2 simple sutures micro stitches. Sixty days clinical follow-up and brain imaging control provided data results. Results: All patients treated with 2-1-2 MST technique had complete thrombus removal by precise surgical maneuvers avoiding surgeons unplanned and insecure movements to reduced operation time. Head angio-CT scan evidenced complete cerebrovascular circulation re-flow with clinical improvements in 60 days follow-up without complications or hospital readmissions. Conclusions: 2-1-2 MST technique can be rapidly and efficaciously performed in a systemized manner offering a tertiary or salvage technique for acute stroke treatment. Specific microsurgical training is mandatory to accomplish this treatment and larger studies are necessary to confirm our hypothesis.
Databáze:	MEDLINE
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