Direct Microsurgical Embolectomy for Acute Occlusion of the Internal Carotid Artery and Middle Cerebral Artery
| Autor: | Hisatomi Arima, Hideki Oka, Tetsuya Katsumori, Akihiko Hino, Akihiro Fujii, Tadashi Echigo, Kazuhiko Nozaki, Naoto Shiomi, Hirokazu Koseki, Naoya Hashimoto, Youichi Hashimoto |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Operative Time Cerebral arteries Embolectomy Comorbidity 030204 cardiovascular system & hematology Revascularization Young Adult 03 medical and health sciences 0302 clinical medicine Japan Risk Factors medicine.artery Occlusion Prevalence medicine Humans Carotid Stenosis Retrospective Studies Surgical team Cerebral Revascularization medicine.diagnostic_test business.industry Infarction Middle Cerebral Artery Magnetic resonance imaging Surgery Survival Rate Treatment Outcome Acute Disease Middle cerebral artery Female Neurology (clinical) Internal carotid artery business 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 88:243-251 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2015.12.069 |
| Popis: | Background Surgical embolectomy is the most promising therapy for physically removing emboli from major cerebral arteries. However, it requires an experienced surgical team, time-consuming steps, and is not incorporated into acute stroke therapy. Methods We established seamless collaboration between services, refined surgical techniques, and conducted a prospective trial of emergency surgical embolectomy. Surgical indications included the presence of acute hemispheric symptoms, absence of low-density area on computed tomography, evidence of internal carotid artery terminus or proximal middle cerebral artery occlusion, and availability of resources to start surgery within 3 hours of symptom onset. The indications were confirmed by an interdisciplinary team. We assessed revascularization rates, time from admission to surgery and from surgery to recanalization, procedural complications, and clinical outcomes. Results Between 2005 and 2014, 14 consecutive patients with acute proximal middle cerebral artery or internal carotid artery terminus occlusion underwent emergency surgical embolectomy. All patients showed complete recanalization. Twelve patients survived and 7 had fair functional outcome (Rankin Scale score, ≤3). No significant procedural adverse events occurred. The mean times from admission to start of surgery, from surgery to recanalization, and from onset to recanalization were 14 minutes, 79 minutes, and 223 minutes, respectively. Conclusions Our results suggest that microsurgical embolectomy can rapidly, safely, and effectively retrieve clots and deserves reappraisal, although the choice largely depends on local institutional expertise. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect