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Article: Successful emergency rescue open embolectomy for failed endovascular thrombectomy in acute ischemic stroke: 2-dimensional operative video

TitleSuccessful emergency rescue open embolectomy for failed endovascular thrombectomy in acute ischemic stroke: 2-dimensional operative video
Authors
KeywordsSurgical embolectomy
Craniotomy
Large vessels occlusion
Rescue
Stroke
Issue Date2019
PublisherOxford University Press.
Citation
Operative Neurosurgery, 2019, Epub on 2019-06-04 How to Cite?
AbstractThis operative video demonstrates an open surgical thrombectomy for a 61-yr-old woman with failed endovascular embolectomy in acute ischemic stroke. Good functional outcome can be achieved when this operation is timely performed within the therapeutic window. This patient has atrial fibrillation. She was admitted for sudden onset of left-sided hemiplegia and aphasia. National Institutes of Health Stroke Scale (NIHSS) was 20/42 before the operation. Computed tomography (CT) cerebral angiogram showed right internal cerebral artery (ICA) occlusion from the cervical portion. Urgent intra-arterial (IA) thrombectomy was started 2 h after symptom onset, but failed despite the use of a stentriver and a large-bore aspiration catheter together. Emergency rescue open thrombectomy was performed with right pterional craniotomy 6 h after symptom onset. Sylvian fissure was dissected to expose the supraclinoid ICA, ICA bifurcation, A1, and M1. A transverse arteriotomy was made at the ICA bifurcation and open surgical thrombectomy was performed. Reperfusion was established in 86 min after skin incision. Intraoperative indocyanine green video-angiography showed patent flow over ICA bifurcation to M1 and A1. She had a good recovery with the return of the left-sided power and was discharged home. At 2-mo postoperative assessment, she was able to walk unaided independently. The modified Barthel Index (BI) was 74/100. Her activity of daily living was independent. We must emphasize IA thrombectomy is the standard treatment, and the role of open surgery remains a potential rescue procedure. Good functional outcome can be achieved when emergency rescue open thrombectomy is performed within the therapeutic window.
DescriptionLink to Free access
Persistent Identifierhttp://hdl.handle.net/10722/271300
ISSN
2020 Impact Factor: 2.703
2020 SCImago Journal Rankings: 0.791
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorChan, DYC-
dc.contributor.authorTsang, ACO-
dc.contributor.authorTsang, FCP-
dc.contributor.authorLi, LF-
dc.contributor.authorHo, WS-
dc.contributor.authorLui, WM-
dc.contributor.authorLeung, GKK-
dc.date.accessioned2019-06-24T01:07:13Z-
dc.date.available2019-06-24T01:07:13Z-
dc.date.issued2019-
dc.identifier.citationOperative Neurosurgery, 2019, Epub on 2019-06-04-
dc.identifier.issn2332-4252-
dc.identifier.urihttp://hdl.handle.net/10722/271300-
dc.descriptionLink to Free access-
dc.description.abstractThis operative video demonstrates an open surgical thrombectomy for a 61-yr-old woman with failed endovascular embolectomy in acute ischemic stroke. Good functional outcome can be achieved when this operation is timely performed within the therapeutic window. This patient has atrial fibrillation. She was admitted for sudden onset of left-sided hemiplegia and aphasia. National Institutes of Health Stroke Scale (NIHSS) was 20/42 before the operation. Computed tomography (CT) cerebral angiogram showed right internal cerebral artery (ICA) occlusion from the cervical portion. Urgent intra-arterial (IA) thrombectomy was started 2 h after symptom onset, but failed despite the use of a stentriver and a large-bore aspiration catheter together. Emergency rescue open thrombectomy was performed with right pterional craniotomy 6 h after symptom onset. Sylvian fissure was dissected to expose the supraclinoid ICA, ICA bifurcation, A1, and M1. A transverse arteriotomy was made at the ICA bifurcation and open surgical thrombectomy was performed. Reperfusion was established in 86 min after skin incision. Intraoperative indocyanine green video-angiography showed patent flow over ICA bifurcation to M1 and A1. She had a good recovery with the return of the left-sided power and was discharged home. At 2-mo postoperative assessment, she was able to walk unaided independently. The modified Barthel Index (BI) was 74/100. Her activity of daily living was independent. We must emphasize IA thrombectomy is the standard treatment, and the role of open surgery remains a potential rescue procedure. Good functional outcome can be achieved when emergency rescue open thrombectomy is performed within the therapeutic window.-
dc.languageeng-
dc.publisherOxford University Press.-
dc.relation.ispartofOperative Neurosurgery-
dc.rightsPre-print: Journal Title] ©: [year] [owner as specified on the article] Published by Oxford University Press [on behalf of xxxxxx]. All rights reserved. Pre-print (Once an article is published, preprint notice should be amended to): This is an electronic version of an article published in [include the complete citation information for the final version of the Article as published in the print edition of the Journal.] Post-print: This is a pre-copy-editing, author-produced PDF of an article accepted for publication in [insert journal title] following peer review. The definitive publisher-authenticated version [insert complete citation information here] is available online at: xxxxxxx [insert URL that the author will receive upon publication here].-
dc.subjectSurgical embolectomy-
dc.subjectCraniotomy-
dc.subjectLarge vessels occlusion-
dc.subjectRescue-
dc.subjectStroke-
dc.titleSuccessful emergency rescue open embolectomy for failed endovascular thrombectomy in acute ischemic stroke: 2-dimensional operative video-
dc.typeArticle-
dc.identifier.emailTsang, ACO: acotsang@hku.hk-
dc.identifier.emailTsang, FCP: tcp199@hku.hk-
dc.identifier.emailLi, LF: lfrandom@hku.hk-
dc.identifier.emailHo, WS: howsw@hku.hk-
dc.identifier.emailLui, WM: mattlui@hku.hk-
dc.identifier.emailLeung, GKK: gkkleung@hku.hk-
dc.identifier.authorityTsang, ACO=rp01519-
dc.identifier.authorityLeung, GKK=rp00522-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1093/ons/opz140-
dc.identifier.scopuseid_2-s2.0-85079347801-
dc.identifier.hkuros298093-
dc.identifier.volumeEpub on 2019-06-04-
dc.identifier.isiWOS:000522860100013-
dc.publisher.placeUnited States-
dc.identifier.issnl2332-4252-

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