Emergent microsurgical intervention for acute stroke after mechanical thrombectomy failure: a prospective study

Area of Science:

• Neurology
• Neurosurgery
• Vascular Surgery

Background:

• Despite advances in mechanical thrombectomy and thrombolysis for acute ischemic stroke, a subset of patients with persistent large vessel occlusion experience poor outcomes.
• Salvageable brain tissue in these patients remains at risk due to the limitations of current endovascular techniques.

Purpose of the Study:

• To evaluate the safety and efficacy of emergent microsurgical intervention for acute ischemic stroke patients with symptomatic middle cerebral artery occlusion.
• To assess microsurgical embolectomy and/or extracranial-intracranial bypass as a salvage strategy after failed mechanical thrombectomy.

Main Methods:

• A prospective, two-center cohort study enrolled patients with acute ischemic stroke and middle cerebral artery occlusion.
• Patients with failed recanalization were randomized to microsurgical intervention (MSIG) or a control group (CG1) at center 1.
• A second control group (CG2) comprised similar patients at center 2 who did not undergo surgical intervention.

Main Results:

• The microsurgical intervention group (MSIG) demonstrated significantly better 90-day functional outcomes (modified Rankin Scale 0-2) in 58.3% of patients.
• Control groups (CG1 and CG2) showed lower rates of favorable outcomes at 10.0% and 12.0%, respectively.
• This suggests a potential benefit of microsurgical intervention in selected stroke patients.

Conclusions:

• Emergent microsurgical techniques can be a viable third-tier treatment option for acute ischemic stroke.
• Microsurgical intervention showed promising results in achieving good functional outcomes for patients with persistent large vessel occlusion after endovascular treatment failure.
• Further research may solidify the role of microsurgery in the stroke treatment algorithm.