| Extended superciliary approach for middle cerebral artery embolectomy after unsuccessful endovascular recanalization therapy: technical note. | |
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MedLine Citation:
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PMID: 19934937 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Although an intra-arterial mechanical embolectomy extends the therapeutic time window for restoration of the cerebral blood flow, its suboptimal recanalization rate also necessitates a salvage procedure if the patient is still within the therapeutic time window. As such, a surgical embolectomy can be performed in a rapid and less invasive manner for an acute middle cerebral artery (MCA) occlusion. The technical details of this procedure are discussed and demonstrated. METHODS: Four patients with an acute MCA occlusion were treated using a novel surgical embolectomy technique after unsuccessful intra-arterial mechanical recanalization therapy. Unique to the proposed surgical technique are a laterally extended superciliary approach, small (3-mm) arteriotomy, and closure of the arteriotomy using an aneurysm clip after removal of the intravascular embolus. RESULTS: Occluded MCAs were successfully recanalized using the present technique, and the operative time from skin incision to recanalization was 1 to 1.5 hours in each patient. One to 3 arteriotomies were made in each patient. Six of the 8 arteriotomies in the present series were closed using an aneurysm clip, whereas the other 2 arteriotomies were repaired using microsutures. Postoperative angiograms demonstrated patent MCAs without remarkable clip-induced stenosis. The successful recanalization provided considerable neurological improvement in all patients without procedural complications, except for 1 patient with a fatal putaminal hemorrhage resulting from a reperfusion injury. CONCLUSION: A laterally extended superciliary approach and clip application for arteriotomy closure enable a surgical embolectomy to become a rapid and less invasive procedure. |
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Authors:
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Jaechan Park; Yang-Ha Hwang; Yongsun Kim |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Neurosurgery Volume: 65 ISSN: 1524-4040 ISO Abbreviation: Neurosurgery Publication Date: 2009 Dec |
Date Detail:
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Created Date: 2009-11-25 Completed Date: 2010-02-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: United States |
Other Details:
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Languages: eng Pagination: E1191-4; discussion E1194 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, Brain Science and Engineering Institute, Kyungpook National University, Daegu, Republic of Korea. jparkmd@hotmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Embolectomy / methods* Female Humans Infarction, Middle Cerebral Artery / surgery* Magnetic Resonance Imaging / methods Male Middle Aged Postoperative Complications / prevention & control Tissue Plasminogen Activator / therapeutic use Tomography, X-Ray Computed / methods Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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EC 3.4.21.68/Tissue Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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