Tetsuyoshi Horiuchi1, Junpei Nitta2, Yoshinari Miyaoka3, Alhusain Nagm4, Keiji Tsutsumi4, Kiyoshi Ito4, Kazuhiro Hongo4. 1. Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Kobayashi Neurosurgical Hospital, Nagano, Japan. Electronic address: tetuyosi@shinshu-u.ac.jp. 2. Kobayashi Neurosurgical Hospital, Nagano, Japan. 3. Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Kobayashi Neurosurgical Hospital, Nagano, Japan. 4. Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Abstract
BACKGROUND: Mechanical endovascular embolectomy using stent retrievers has gained popularity for treatment of large vessel occlusion in acute ischemic stroke. Use of open embolectomy as a direct surgical treatment has been limited, likely owing to the technical difficulty, therapeutic time window, and time-consuming procedure. METHODS: We retrospectively reviewed clinical and radiographic records of patients who underwent open embolectomy for major artery occlusion at an acute stage. Clinical features, complications, and outcome of patients were analyzed. RESULTS: From January 2004 to September 2016, 153 patients underwent 157 open embolectomies for major artery occlusion. Complete recanalization was achieved in 96.2% of patients. A favorable outcome was observed in 43.9%. Cerebral aneurysm along the occluded artery was observed in 11 patients with 12 aneurysms. CONCLUSIONS: Open embolectomy resulted in a high complete recanalization rate with an acceptable safety profile. Open embolectomy is a safe and durable method of cerebral recanalization in patients with embolic stroke and can be considered as a potential treatment if endovascular embolectomy cannot be performed. The details of the occluded arteries presented here will be useful for endovascular surgeons to prevent complications.
BACKGROUND: Mechanical endovascular embolectomy using stent retrievers has gained popularity for treatment of large vessel occlusion in acute ischemic stroke. Use of open embolectomy as a direct surgical treatment has been limited, likely owing to the technical difficulty, therapeutic time window, and time-consuming procedure. METHODS: We retrospectively reviewed clinical and radiographic records of patients who underwent open embolectomy for major artery occlusion at an acute stage. Clinical features, complications, and outcome of patients were analyzed. RESULTS: From January 2004 to September 2016, 153 patients underwent 157 open embolectomies for major artery occlusion. Complete recanalization was achieved in 96.2% of patients. A favorable outcome was observed in 43.9%. Cerebral aneurysm along the occluded artery was observed in 11 patients with 12 aneurysms. CONCLUSIONS: Open embolectomy resulted in a high complete recanalization rate with an acceptable safety profile. Open embolectomy is a safe and durable method of cerebral recanalization in patients with embolic stroke and can be considered as a potential treatment if endovascular embolectomy cannot be performed. The details of the occluded arteries presented here will be useful for endovascular surgeons to prevent complications.