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Embolectomy for acute embolic occlusion of the internal carotid artery bifurcation
H Touho1, T Morisako, Y Hashimoto
1Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Japan.
Insights
Emergency embolectomy offers a higher recanalization rate for acute internal carotid artery (ICA) occlusion within 6 hours of symptom onset. This surgical intervention shows promise compared to thrombolytic therapy for severe hemispheric ischemia.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Neuroradiology
Background:
- Acute occlusion of the internal carotid artery (ICA) causes severe hemispheric ischemia with poor outcomes.
- Existing treatments, including endovascular options, have shown limited recanalization and high mortality rates.
Purpose of the Study:
- To evaluate the efficacy of emergency embolectomy for acute internal carotid artery (ICA) bifurcation occlusion.
- To determine the recanalization rate and clinical outcomes associated with this procedure.
Main Methods:
- Six patients with acute embolic ICA bifurcation occlusion, admitted within 2 hours of symptom onset, underwent emergency embolectomy.
- Angiography was performed to assess recanalization, with CT scans used to evaluate infarction.
Main Results:
- Successful recanalization was achieved in 4 out of 6 patients (66.7%) within 6 hours of symptom onset.
- Two patients died due to uncal herniation; among survivors, functional outcomes varied.
- The recanalization rate for embolectomy was significantly higher than reported rates for thrombolytic therapy (12.5%).
Conclusions:
- Emergency open embolectomy is a viable treatment option for acute internal carotid artery (ICA) occlusion when performed within 6 hours of symptom onset.
- This surgical approach demonstrates a superior recanalization rate compared to thrombolytic therapy.
Background:
Acute occlusion of the distal intracranial segment of the internal carotid artery (ICA) causes sudden severe hemispheric ischemia. A low rate of recanalization and a high mortality rate for this condition have been noted, even with endovascular treatment.
Methods:
We report the results of emergency embolectomy in six patients with acute embolic occlusion of the internal carotid artery (ICA) bifurcation. All six patients were admitted to our institute within 2 h of the onset of symptoms. Computed tomography (CT) scans on admission revealed no low-density or high-density regions in any patients. The time between onset of symptoms and completion of angiography ranged from 2 to 4 h (2.8 +/- 0.7 h).
Results:
Emergency embolectomy was performed for each patient. Recanalization was confirmed angiographically in four of the patients. In the remaining two patients, massive infarction in the territory of the ICA was detected on the CT scans obtained the day of the operation, and postoperative angiography was not performed in these two cases. These two patients died of uncal herniation 6 days after onset. Two of the six patients were able to walk with a cane 2 months after surgery. The remaining two patients were unable to walk or attend to their own bodily needs without assistance. The time elapsed between onset of symptoms to reopening of the occluded vessel was within 6 h in the four surviving patients. The recanalization rate was 66.7% (4/6) for the embolectomy procedure, significantly higher than that (12.5%) of the thrombolytic therapy reported in a previous study.
Conclusions:
In summary, open embolectomy can be performed when the time after onset of symptoms is less than 6 h.