Urgent open embolectomy for cardioembolic cervical internal carotid artery occlusion

Abstract

Acute ischemic stroke attributable to cervical internal carotid artery (ICA) occlusion is frequently associated with severe disability or death, and is usually caused by atherosclerosis. By contrast, the cardioembolic cervical ICA occlusion is rare, and feasibility of urgent recanalization remains unclear. We present the first study in the literature that focuses on urgent open embolectomy for treatment of cardioembolic cervical ICA occlusion. A retrospective review of the charts for patients undergoing open embolectomy was performed. Between April 2006 and September 2007, 640 consecutive patients with acute ischemic stroke were treated. Of them, 3 patients (0.47%) with the acute complete cardioembolic cervical ICA occlusion underwent urgent open embolectomy. All patients presented with profound neurological deficits and atrial fibrillation. The urgent open embolectomy achieved complete recanalization in all patients without any complications. All emboli in 3 patients were very large and fibrinous in histological findings. Two of 3 patients showed rapid improvement in neurological functions after surgical treatments. The cardioembolic occlusion of the cervical ICA is rare, but its possibility should be considered in patients with the acute ischemic stroke suffering profound neurological deficits and atrial fibrillation. Urgent open embolectomy may be a treatment option to obtain successful recanalization for cardioembolic cervical ICA occlusion and is recommended because it is technically easier and similar to the carotid endarterectomy.

Emergency EC-IC bypass for symptomatic atherosclerotic ischemic stroke

“…Embolus or atherosclerosis was diagnosed based on the past history such as atrial fibrillation and neuroimages. The embolic stroke in patients with insufficient endovascualr recanalization was treated by the open embolectomy [3,4,6,8].…”

“…When it was difficult to distinguish the atherosclerosis from the embolus preoperatively, the affected artery was directly visualized and the appropriate surgery was carried out. Surgical indications of urgent revascularization were previously reported in detail [4,6]. Briefly, inclusion criteria were: (1) the patient who needed no supports for daily life before ictus, Data analysis was carried out using a statistical software package (PASW Statistics 18, SPSS Japan).…”

“…By contrast, surgical revascularization may be effective to some patients who suffered from medication-resistance hemodynamic stroke in acute stage [3][4][5][6][7]10]. However, safety and efficacy of surgical revascularization for ischemic stroke in acute stage is still controversial.…”

“…However, safety and efficacy of surgical revascularization for ischemic stroke in acute stage is still controversial. We have reported the efficacy of urgent embolectomy for the ICA or MCA occlusion caused by embolism [4,6]. In the present study, we analyzed our experience with early EC-IC bypass in acute ischemic stroke and stroke in progress due to arteriosclerosis.…”

Emergent intracranial surgical embolectomy in conjunction with carotid endarterectomy for acute internal carotid artery terminus embolic occlusion and tandem occlusion of the cervical carotid artery due to plaque rupture

“…The embolus was extracted with the inserted shunt tube after deflation of the balloon (Figs. 1D and 2F and G) following the technique described by McCormick et al 11 and Murata et al 12 An adequate backflow from the ophthalmic artery was thus obtained. Then, the intracranial temporary clip at the C 2 segment was removed.…”