Emergent microsurgical intervention for acute stroke after mechanical thrombectomy failure: a prospective study.

Autor:	Fiedler J; Department of Neurosurgery, Nemocnice České Budějovice, České Budějovice, Jihočeský, Czech Republic.; Department of Neurosurgery, Univerzita Karlova Lékařská fakulta v Plzni, Plzeň, Plzeňský, Czech Republic., Roubec M; Department of Neurology, University Hospital Ostrava, Ostrava, Moravskoslezský, Czech Republic.; Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Moravskoslezský, Czech Republic., Grubhoffer M; Department of Neurosurgery, Nemocnice České Budějovice, České Budějovice, Jihočeský, Czech Republic.; Department of Neurosurgery, Univerzita Karlova Lékařská fakulta v Plzni, Plzeň, Plzeňský, Czech Republic., Ostrý S; Department of Neurology, Nemocnice České Budějovice, České Budějovice, Jihočeský, Czech Republic.; Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Praha, Praha, Czech Republic., Procházka V; Department of Radiology, University Hospital Ostrava, Ostrava, Moravskoslezský, Czech Republic., Langová K; Department of Biophysics, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Olomoucký, Czech Republic., Školoudík D; Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Moravskoslezský, Czech Republic skoloudik@hotmail.com.; Department of Radiology, University Hospital Ostrava, Ostrava, Moravskoslezský, Czech Republic.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2023 May; Vol. 15 (5), pp. 439-445. Date of Electronic Publication: 2022 Apr 15.
DOI:	10.1136/neurintsurg-2022-018643
Abstrakt:	Background: Despite all the gains that have been achieved with endovascular mechanical thrombectomy revascularization and intravenous thrombolysis logistics since 2015, there is still a subgroup of patients with salvageable brain tissue for whom persistent emergent large vessel occlusion portends a catastrophic outcome. Objective: To test the safety and efficacy of emergent microsurgical intervention in patients with acute ischemic stroke and symptomatic middle cerebral artery occlusion after failure of mechanical thrombectomy. Methods: A prospective two-center cohort study was conducted. Patients with acute ischemic stroke and middle cerebral artery occlusion for whom recanalization failed at center 1 were randomly allocated to the microsurgical intervention group (MSIG) or control group 1 (CG1). All similar patients at center 2 were included in the control group 2 (CG2) with no surgical intervention. Microsurgical embolectomy and/or extracranial-intracranial bypass was performed in all MSIG patients at center 1. Results: A total of 47 patients were enrolled in the study: 22 at center 1 (12 allocated to the MSIG and 10 to the CG1) and 25 patients at center 2 (CG2). MSIG group patients showed a better clinical outcome on day 90 after the stroke, where a modified Rankin Scale score of 0-2 was reached in 7 (58.3%) of 12 patients compared with 1/10 (10.0%) patients in the CG1 and 3/12 (12.0%) in the CG2. Conclusions: This study demonstrated the potential for existing microsurgical techniques to provide good outcomes in 58% of microsurgically treated patients as a third-tier option. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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