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Neurosurgical Review
Published in: Neurosurgical Review 4/2015

01-10-2015 | Original Article

Surgical embolectomy for internal carotid artery terminus occlusion

Authors: Tomohiro Inoue, Akira Tamura, Kazuo Tsutsumi, Isamu Saito, Nobuhito Saito

Published in: Neurosurgical Review | Issue 4/2015

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Abstract

The aim of this study was to assess the efficacy and safety of surgical embolectomy for internal carotid artery terminus (ICA-T) occlusion. Twenty-five consecutive patients with acute ischemic stroke attributed to embolic ICA-T occlusion who underwent surgical embolectomy were retrospectively reviewed. Twenty-four patients were examined based on magnetic resonance imaging, with one patient included based on a computed tomography scan. Recanalization rate, recanalization time, complications, National Institutes of Health Stroke Scale (NIHSS) score improvement at 1 month, and modified Rankin Scale (mRS) at 3 months were evaluated. Final recanalization status was Thrombolysis in Myocardial Infarction (TIMI) 3 in 24 patients (96 %). Median recanalization time from symptom onset and from start of surgery was 281 and 79 min, respectively. Two patients (8 %) had major hemorrhagic complications related to surgery. Seventeen patients (68 %) demonstrated NIHSS score improvement of more than 10 points at 1 month. At 3 months, eight patients (32 %) were mRS 0–2, five patients (20 %) were mRS 3, and three patients (12 %) had died. Surgical embolectomy for ICA-T occlusion demonstrated a high complete recanalization rate and should be reconsidered as an additional therapeutic strategy to overcome this devastating situation.
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Literature
1.
Bhatia R, Hill MD, Shobha N, Menon B, Bal S, Kochar P, Watson T, Goyal M, Demchuk AM (2010) Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke. Real-world experience and a call for action. Stroke 41:2254–2258CrossRefPubMed
2.
Fischer U, Mono ML, Schroth G, Jung S, Mordasini P, El-Koussy M, Weck A, Brekenfeld C, Findling O, Galimanis A, Heldner MR, Arnold M, Mattle HP, Gralla J (2013) Endovascular therapy in 201 patients with acute symptomatic occlusion of the internal carotid artery. Eur J Neurol 20:1017–1024CrossRefPubMed
3.
Hasegawa H, Inoue T, Tamura A, Saito I (2015) 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. J Neurosurg 122: 939–47
4.
Horiuchi T, Nitta J, Sakai K, Tanaka Y, Hongo K (2007) Emergency embolectomy for treatment of acute middle cerebral artery occlusion. J Neurosurg 106:257–26CrossRefPubMed
5.
Inoue T, Tamura A, Tsutsumi K, Saito I, Saito N (2013) Surgical embolectomy for large vessel occlusion of anterior circulation. Br J Neurosurg 27:783–790CrossRefPubMed
6.
Inoue T, Tamura A, Tsutsumi K, Saito I, Saito N (2014) Response to “Role of surgical versus endovascular embolectomy for the treatment of acute large vessel occlusion”. Br J Neurosurg 28:431–432CrossRefPubMed
7.
Lansberg MG, Thijs VN, Bammer R, Olivot JM, Marks MP, Wechsler LR, Kemp S, Albers GW (2008) The MRA-DWI mismatch identifies patients with stroke who are likely to benefit from reperfusion. Stroke 39:2491–2496PubMedCentralCrossRefPubMed
8.
Lin R, Vora N, Zaidi S, Aleu A, Jankowitz B, Thomas A, Gupta R, Horowitz M, Kim S, Reddy V, Hammer M, Uchino K, Lawrence R, Wechsler R, Jovin T (2009) Mechanical approaches combined with intraarterial pharmacological therapy are associated with higher recanalization rates than either intervention alone in revascularization of acute carotid terminus occlusion. Stroke 40:2092–2097CrossRefPubMed
9.
Meyer FB, Piepgras DG, Sundt TM, Yanagihara T (1985) Emergency embolectomy for acute occlusion of the middle cerebral artery. J Neurosurg 62:639–647CrossRefPubMed
10.
Mokin M, Kass-Hout T, Kass-Hout O, Dumont TM, Kan P, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI (2012) Intravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion: a systematic review off clinical outcomes. Stroke 43:2362–2368CrossRefPubMed
11.
Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, Liebeskind DS, Smith WS (2012) Trevo versus Merci retrievers for thrombectomy revascularization of large vessel occlusions in acute ischemic stroke (TREVO 2): a randomized trial. Lancet 380:1231–1240PubMedCentralCrossRefPubMed
12.
Park J, Hwang YH, Kim Y (2009) Extended supercilliary approach for middle cerebral artery embolectomy after unsuccessful endovascular recanalization therapy: technical note. Neurosurgery 65:1191–1194CrossRef
13.
Rha JH, Saver JL (2007) The impact of recanalization on ischemic stroke outcome. A meta-analysis. Stroke 38:967–973CrossRefPubMed
14.
Saqqur M, Uchino K, Demchuk AM, Molina CA, Garami Z, Calleja S, Akhtar N, Orouk FO, Salam A, Shuaib A, Alexandrov AV (2007) Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke 38:948–954CrossRefPubMed
Metadata
Title
Surgical embolectomy for internal carotid artery terminus occlusion
Authors
Tomohiro Inoue
Akira Tamura
Kazuo Tsutsumi
Isamu Saito
Nobuhito Saito
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
Neurosurgical Review / Issue 4/2015
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI
https://doi.org/10.1007/s10143-015-0640-4

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