Outcome predictors of open embolectomy in middle cerebral artery occlusion.
OBJECTIVE
The purpose of this paper was to analyse the outcome of the patients with acute middle cerebral artery (MCA) occlusion treated by open embolectomy.


METHODS
A clinical chart review was retrospectively conducted for 30 patients who had MCA occlusion and were treated with open embolectomy. According to the Glasgow Outcome Scale, the patients' outcome at discharge is divided in two groups: favorable outcome (good recovery and moderate disability) or unfavorable outcome (severe disability, vegetative state and death). The following variables between the favorable and unfavorable outcomes were analysed: age, sex, Glasgow Coma Scale score on admission, affected side, occlusion site, occlusion time, atrial fibrillation on electrocardiogram, fibrinolysis, aphasia, hemiparesis and hemorrhagic infarction after surgery.


RESULTS
The outcomes of 30 patients were favorable in 16 patients (good recovery in nine and moderate disability in seven) and unfavorable in 14 patients (severe disability in 12, vegetative state in one and death in one). The M1 occlusion and fibrinolysis performance were more frequent in the unfavorable outcome group than in the favorable one. Logistic regression analysis with a stepwise method indicated that the only occlusion site was independently associated with the unfavorable outcome. The occlusion time >360 minutes was not the predictor of the unfavorable outcome.


CONCLUSIONS
The outcome of patients with MCA occlusion treated by the open embolectomy depends on the occlusion site and the fibrinolysis performance in the present study. The M1 occlusion is also the independent risk factor of the unfavorable outcome. However, the occlusion time itself has no relation to the unfavorable outcome. These results indicate that therapeutic time windows vary in individuals probably due to the collateral blood flow.
Horiuchi
Tetsuyoshi
T
Department of Neurosurgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan. tetuyosi@shinshu-u.ac.jp
Nitta
Junpei
J
Ogiwara
Toshihiro
T
Sakai
Keiichi
K
Hongo
Kazuhiro
K
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D017128:Embolectomy / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D010291:Paresis / Q000453:epidemiology; D018458:Persistent Vegetative State / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors