Summary: Extracranial-intracranial (EC-IC) bypass is one of the most fundamental techniques for cerebrovascular surgery. We describe our surgical results and strategy for performing the EC-IC bypass safely and precisely in patients with chronic stage ischemia. Surgical indications were decided for symptomatic internal carotid or middle cerebral artery occlusive disease with misery perfusion detected using quantitative single-photon emission computed tomography. Antiplatelet medications were continued, and intravenous hyperosmotic colloid infusion was started 1 week before operation.Target recipient M4 arteries were superimposed on the superficial temporal artery and cranial bone.Preparation of the superficial temporal artery was performed by using an ultrasound instrument (Harmonic Scalpel ® ). The craniotomy site was located under the supratemporal line. Various anastomotic techniques were adopted, including continuous, running, and intermittent suturing methods. The second target recipient artery was confirmed using intra-arterial indocyanine green videoangiography.
Key words: ・ suction decompression ・ paraclinoid aneurysm ・ surgical result Surg Cereb Stroke (Jpn) 43: 18-25, 2015 Summary: Introduction: Surgical clipping of a paraclinoid aneurysm can be very difficult because strong adhesion may hinder the dissection of the perforators and surrounding anatomical structures from the aneurysm dome. We describe our experience of performing retrograde suction decompression during the clipping of paraclinoid internal carotid artery (ICA) aneurysms, and discuss the advantages and pitfalls of the technique. Materials and methods: In this retrospective study, we enrolled 22 consecutive patients, 20 females and 2 males aged 37-78 years (mean, 64 years), including 13 patients with large and 4 patients with giant intracranial aneurysms treated with clipping surgery through suction decompression assistance between March 2004 and August 2013. Direct puncture of the common carotid artery was performed using a 20-gauge needle. The aneurysm was trapped by clamping the common carotid and external carotid arteries followed by temporary clipping of the intracranial ICA distal to the aneurysm neck.Blood was then gently aspirated through a catheter introduced into the cervical ICA, resulting in the collapse of the aneurysm. The aneurysm dome was detached from the perforators and surrounding structures during blood flow interruption, which could be maintained for up to 5 min. This procedure was repeated until the dissection and clipping of the aneurysm were completed. Control angiography was usually performed to confirm complete clipping of the aneurysm and the restoration of blood flow in the intracranial ICA.Results: The admitted patients included 6 patients with a ruptured aneurysm resulting in subarach-
Objective: Mechanical thrombectomy (MT) for middle cerebral artery M2 occlusion (M2O) is challenging because the procedure is performed in a narrow and tortuous artery. In this study, we compared MT using an aspiration catheter (AC) versus a stent retriever (SR) used alone, and retrospectively evaluated the efficacy and safety of MT using an AC for M2O.Methods: Seventy-four consecutive patients who underwent MT for M2O at our institution between April 2016 and April 2020 were evaluated. The subjects were classified into those treated by AC (AC group) or SR alone (SR group). The AC group included patients treated by both contact aspiration and a combination technique of AC and SR. Background factors and outcomes, including modified treatment in cerebral infarction (mTICI) 2c-3 recanalization, were compared between the groups.Results: AC and SR groups consisted of 47 and 27 patients respectively. Among them, the rate of mTICI 2b-3 was 93.6% vs 92.6%, and that of mTICI 2c-3 was 72.3% vs 48.2% (P = 0.004). The perioperative symptomatic subarachnoid hemorrhage (SAH) rate was 0% vs 7.4%, and modified Rankin scale scores of 0-2 were 78.6% vs 50% (P = 0.03). In the AC group, the mTICI 2c-3 rate was higher in patients in whom the AC was adequately advanced to the thrombus compared to those with inadequate AC advancement (83.3% vs 36.3%, P = 0.002).
Conclusion:The rate of mTICI 2c-3 was higher in the AC than SR group, with no cases of symptomatic SAH. MT using AC for M2O might achieve safe and effective thrombectomy.
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