Microsurgical thrombectomy: where the ancient art meets the new era

Abstract

BackgroundMechanical thrombectomy (MT) is the leading treatment for acute large vessel occlusion (LVO). However, surgical thrombectomy (ST) may have a role in well selected LVO patients where MT failed to re-establish ow, the endovascular route is inaccessible, or where MT is a nancially prohibitive or absent option(developing and poor countries). We compared the e cacy and e ciency between ST and MT, and described our operative experience and its potential application in the developing world. MethodsClinical outcomes, procedural times and e cacy of treatment were compared between the MT and ST of acute LVO between 2012 and 2022. Propensity score-matched analysis was also conducted to compare MT and ST. ResultsOne-hundred nine patients ful lled the study criteria (77MTs vs 32STs). Factors driving outcome were age (aOR:0.95, 95%CI, 0.91-0.98), hemisphere side (aOR:0.38, 95%CI, 0.15-0.96), DWI-ASPECT (aOR:1.39, 95%CI, 1.09-1.77) at presentation by the multivariate analysis. Times from door-start of procedure(P=0.45), and start of procedure-recanalization(P=0.13) were similar between treatment options. Propensity score-matched analysis found no signi cant difference for 2 treatment methods about time of door to recanalization(P=0.155) and outcome(P=0.221). ConclusionsThe prognosticator of thrombectomy for acute LVO in patients with successful recanalization were age, affected hemisphere side and DWI-ASPECT score. Our evidence shows that the e cacy of ST is similar to that of MT. There should be a place of ST for cases of mechanical failure or tandem cervical ICA and MCA occlusion. ST may be a temporizing LVO treatment option in healthcare systems where MT is inexistent or nancially prohibitive to patients.