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Emergency embolectomy for embolic occlusion of the middle cerebral artery-review of the literature and two illustrative cases.
MedLine Citation:
PMID:  20838840     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
With the increasing number of endovascular interventions during the last years, the number of procedure-related complications has risen accordingly. Despite sophisticated and effective endovascular treatments for acute thromboembolic events during intervention, vessel occlusion can remain refractory to medical and endovascular treatment. In case of failure of the endovascular revascularisation, microsurgical embolectomy in the anterior circulation can be a last therapeutic option, if case selection is adequate. To date, this rather aggressive form of treatment is still controversial, and there are only few series of reported surgical embolectomy. In the present review, we conducted a Medline (www.pubmed.org) search for reports or studies of microsurgical embolectomies using the keywords (1) middle cerebral artery (MCA) occlusion and (2) embolectomy. The most relevant factors for positive outcome were concluded as such: (1) vessel occlusion time, (2) collateral flow, (3) occlusion site and (4) thromboembolic origin. Additionally, we report on two illustrative cases from our department with acute MCA occlusion treated by emergency microsurgical embolectomy but with very contrary outcomes. Hence, emergency embolectomy in patients with MCA occlusion following endovascular treatment can be quite effective, if endovascular recanalisation options fail. Nevertheless, the decision-making process must be made critically, fast and based on factors such as vessel occlusion time, sufficient collateral flow, occlusion site and thrombus origin.
Authors:
Nima Etminan; Hans-Jakob Steiger; Daniel Hänggi
Publication Detail:
Type:  Journal Article     Date:  2010-09-14
Journal Detail:
Title:  Neurosurgical review     Volume:  34     ISSN:  1437-2320     ISO Abbreviation:  Neurosurg Rev     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7908181     Medline TA:  Neurosurg Rev     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  21-8     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Heinrich Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany. etminan@uni-duesseldorf.de
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