Related Experiment Videos
[Middle cerebral artery endarterectomy: a case report]
Y Matsuoka1, K Kawajiri, K Hayazaki
1Department of Neurosurgery, Saiseikai Ibaraki Hospital, Osaka.
No Shinkei Geka. Neurological Surgery
|September 1, 1993
Summary
Heparin use during middle cerebral artery endarterectomy may prevent mural thrombus formation and subsequent neurological deficits like hemiplegia. This case highlights the importance of anticoagulation in preventing post-operative complications.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Crescendo transient ischemic attacks (TIAs) in a 45-year-old male indicated severe stenosis of the middle cerebral artery (MCA).
- Surgical intervention via endarterectomy was performed on the MCA's horizontal portion (M1) due to escalating TIA frequency and duration.
Observation:
- Post-endarterectomy, the patient developed left hemiplegia, with angiography revealing severe stenosis at the operative site due to mural thrombus.
- An emergency STA-MCA anastomosis was performed, but the hemiplegia persisted, with CT scans showing a low-density area in the basal ganglia and internal capsule.
Findings:
- Post-operative angiography confirmed resolution of MCA stenosis two weeks after the anastomosis.
- The acute mural thrombus formation at the M1 segment was strongly suspected as the cause of the neurological deficit.
Implications:
- This case suggests that intraoperative heparin administration during MCA endarterectomy could prevent acute mural thrombus formation.
- Failure to use anticoagulation may lead to severe neurological deficits, underscoring its critical role in preventing post-surgical thromboembolic events.