Open surgical embolectomy for cardiogenic cerebral embolism: Technical note and its advantages |
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| Institution: | 1. Department of Neurosurgery, Tama Nagayama Hospital, Tokyo, Japan;2. Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan;3. Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan;1. Department of Orthopaedics, NYU Medical Center-Hospital for Joint Diseases, New York, NY, USA;2. Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA;3. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA;4. Department of Orthopaedics, SUNY Downstate Medical Center, New York, NY, USA;5. Department of Orthopaedics, Swedish Neuroscience Institute, Seattle, WA, USA;6. Department of Orthopaedics, University of Kansas Medical Center, Kansas City, KS, USA;7. Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA;8. Department of Neurologic Surgery, Johns Hopkins University, Baltimore, MD, USA;9. Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA;10. Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA;11. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA;1. Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan;2. Department of Neurology, Saiseikai Kumamoto Hospital, Japan;3. Department of Neurology, Minamata City General Hospital & Medical Center, Minamata, Japan;4. Department of Neurology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan;5. Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan;6. Department of Neurology, Kumamoto City Hospital, Kumamoto, Japan;7. Department of Amyloidosis, Nagasaki International University, Sasebo, Japan;1. Department of Radiation Oncology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India;2. Department of Pathology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India;3. Department of Radio-diagnosis and, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India;4. Department of Neuro-surgical Oncology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India;1. Department of Neurology, Jinling Clinical College of Nanjing Medical University, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China;2. Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China;3. Department of Neurology, SIR RUN RUN SHAW Hospital School of Medicine, Zhejiang University, Hangzhou, China;4. Department of Neurology, The Chinese Armed Police Force Guangdong Armed Police Corps Hospital, Guangzhou, China;5. Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China;6. Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, China;8. Department of Neurology, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China;9. Department of Neurology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China;10. Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China;11. Department of Neurology, Huai''an First People''s Hospital, Nanjing Medical University, Huai''an, China;12. Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China |
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| Abstract: | Background and importanceIn cardiogenic cerebral embolism, early recanalization is the most important factor for good prognosis. However, endovascular thrombectomy often fails to achieve recanalization. We present an open surgical embolectomy technique and discuss its advantages.Clinical presentationA 79-year-old woman developed right hemiparesis and severe aphasia. Magnetic resonance imaging revealed an acute cerebral infarction caused by left middle cerebral artery (MCA) occlusion. We attempted endovascular thrombectomy but failed because it was impossible to guide the catheter to the occlusion site. Hence, we converted to open surgical embolectomy. Sylvian fissure was widely opened. After confirming the range of thrombosis using indocyanine green videoangiography (ICGVAG), the proximal and distal arteries were secured, and a temporary clip was placed on the distal M2 to prevent distal thrombosis migration. MCA was cut approximately 3 mm from the bifurcation, and thrombosis was removed using micro-forceps. The proximal clip was simultaneously inserted but was not clamped because the thrombus was extruded by proximal vascular flow. Immediately after removing the thrombus, intense bleeding occurred from the proximal flow. An assistant clamped the proximal artery using the prepared clip, and the incised area of MCA was sutured using 9-0 threads. We finally confirmed blood flow after recanalization using ICGVAG. The time from skin incision to recanalization was 27 min. After the procedure, the patient developed slight aphasia but had no hemiparesis and was later transferred to a rehabilitation hospital.ConclusionOpen surgical embolectomy may be a secondary rescue treatment option in the case of endovascular thrombectomy failure. |
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| Keywords: | Cardiogenic cerebral embolism Recanalization Surgical embolectomy |
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