Direct Microsurgical Embolectomy for Acute Occlusion of the Internal Carotid Artery and Middle Cerebral Artery

Hino, Akihiko; Oka, Hideki; Hashimoto, Youichi; Echigo, Tadashi; Koseki, Hirokazu; Fujii, Akihiro; Katsumori, Tetsuya; Shiomi, Naoto; Nozaki, Kazuhiko; Arima, Hisatomi; Hashimoto, Naoya

doi:10.1016/j.wneu.2015.12.069

Cited by 9 publications

(3 citation statements)

References 38 publications

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“…The method is relatively mature, and there are a large number of clinical trials to prove its safety and effectiveness, and the operation is simple. However, the rate of vascular recanalization after treatment is low, and there is a risk of bleeding, which can fulfil the clinical treatment demands of patients [20][21][22]. With the advancement of medical imaging technology in recent years, NIT technology has become increasingly popular in clinical settings.…”

Section: Discussionmentioning

confidence: 99%

The Feasibility Mechanism of Nerve Interventional Thrombectomy for Occlusion of Cranial Artery M1 and M2 Segments

Fang¹,

Liao²,

Chen³

et al. 2022

Computational and Mathematical Methods in Medicine

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This study was aimed at exploring the feasibility and clinical efficacy of nerve interventional thrombectomy (NIT) to treat occlusion of cranial artery M1 and M2 segments. 80 patients were selected and rolled into a control group (intravenous thrombolysis) and an experimental group (NIT). Patients’ vascular recanalization rates following therapy were compared, and the National Institutes of Health Stroke Scale (NIHSS) was used to measure neurological function. The improvement in hemodynamics and the occurrence of adverse responses were compared. The results showed that the experimental group’s recanalization rate was up to 74.23%, which was significantly greater than the control group’s ( P < 0.05 ). One week after treatment, the neurological function scores in both groups decreased, and the score in the experimental group was only 15.23, which was much lower than that in the control group ( P < 0.05 ). The peak systolic flow rates of the basilar artery, internal carotid artery, and common carotid artery in the experimental group were 132 cm/s, 147 cm/s, and 114 cm/s, respectively, which were lower greatly than those in the control group ( P < 0.05 ). There was no significant difference in incidence of adverse reactions between the two groups ( P > 0.05 ). In summary, NIT showed a significant therapeutic effect on cranial artery occlusion of M1 and M2 segments, can dredge the occluded blood vessels, and effectively improve the neurological deficits of patients, showing reliable feasibility.

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Section: Discussionmentioning

confidence: 99%

The Feasibility Mechanism of Nerve Interventional Thrombectomy for Occlusion of Cranial Artery M1 and M2 Segments

Fang¹,

Liao²,

Chen³

et al. 2022

Computational and Mathematical Methods in Medicine

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“…The first MSE was performed by Jacobson and Donaghy in 1962 9. In other studies with small samples of patients treated with MSE only, the recanalization rate reached 91–100% 10 11…”

Section: Introductionmentioning

confidence: 83%

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

Fiedler

Roubec

Grubhoffer

et al. 2022

J NeuroIntervent Surg

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BackgroundDespite 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.ObjectiveTo 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.MethodsA 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.ResultsA 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.ConclusionsThis study demonstrated the potential for existing microsurgical techniques to provide good outcomes in 58% of microsurgically treated patients as a third-tier option.

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“…The role of surgery in the treatment of acute ischaemic stroke is controversial. Minimally invasive and rapid surgical embolectomy has been proposed as a rescue procedure when endovascular embolectomy fails 8 9. Another surgical option in restoring blood flow if endovascular (or open) embolectomy fails is a bypass.…”

Section: Discussionmentioning

confidence: 99%

When the fat hits the brain—salvage STA–MCA bypass for an intracranial ICA occlusion due to a fat embolus

et al. 2020

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BackgroundLarge fat embolus is a rare but potential reversible cause of ischaemic stroke.Methods and resultsWe describe the neurosurgical management of a complete right internal carotid artery occlusion due to a large fat embolus, caused by a mitral valve replacement.ConclusionKnowledge of acute cerebral ischaemia due to large fat embolism and its hallmark ‘hypodense artery’ is mandatory. Extracranial to intracranial bypass is a feasible rescue treatment after failure of endovascular embolectomy.

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Direct Microsurgical Embolectomy for Acute Occlusion of the Internal Carotid Artery and Middle Cerebral Artery

Cited by 9 publications

References 38 publications

The Feasibility Mechanism of Nerve Interventional Thrombectomy for Occlusion of Cranial Artery M1 and M2 Segments

The Feasibility Mechanism of Nerve Interventional Thrombectomy for Occlusion of Cranial Artery M1 and M2 Segments

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

When the fat hits the brain—salvage STA–MCA bypass for an intracranial ICA occlusion due to a fat embolus

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