title: Surgical embolectomy for large vessel occlusion of anterior circulation.
abstract: OBJECTIVE
  The aim of this study was to assess the technical details and the efficacy and safety of surgical embolectomy for occlusion of large vessels in the anterior circulation.
  
  
  METHODS
  Twenty-three consecutive patients with acute ischemic stroke attributed to embolic occlusion of large arteries of the anterior circulation who underwent treatment with surgical embolectomy were retrospectively reviewed. Twenty patients were treated based on data from magnetic resonance angiography (MRA)-diffusion weighted imaging (DWI) mismatch, while three other patients had contraindications to magnetic resonance imaging (MRI) and were treated based on computed tomography (CT) and digital subtraction angiography (DSA) findings. Clinical outcomes, including recanalization rate, recanalization time, complications, modified Rankin Scale (mRS) at 3 months, and National Institute of Health Stroke Scale (NIHSS) score improvement at 1 month, were evaluated.
  
  
  RESULTS
  Among the 23 patients (median age, 80 years; median presenting NIHSS score, 21 points), the occlusion site was the internal carotid artery (ICA) terminus in six patients, the M1 segment of the middle cerebral artery (MCA) in 10 patients, and the M2 division of the MCA in seven patients. Final recanalization status was thrombolysis in myocardial infarction (TIMI) 3 in 21 patients (91%). Median recanalization time from symptom onset and from start of surgery was 282 min and 70 min, respectively. One patient (4.3%) had symptomatic haemorrhage. Three patients (13%) had brain oedema due to massive infarction of affected vessel area; two of these patients had undergone embolectomy based on CT findings and had successful recanalization, while one patient underwent embolectomy based on MRI findings and did not have successful recanalization. All 18 patients who underwent embolectomy based on MRA-DWI mismatch and had successful recanalization did not develop additional confluent ischaemic lesion on postoperative DWI. At 3 months, seven patients (30%) had a mRS score of 0-2, eight patients (35%) had a mRS score of 3, and none of the patients had died. Sixteen patients (70%) demonstrated NIHSS score improvement of more than eight points at 1 month.
  
  
  CONCLUSIONS
  Surgical embolectomy for occlusion of large vessels in the anterior circulation resulted in a high complete recanalization rate with an acceptable safety profile. Use of MRA-DWI mismatch as an indication for surgical embolectomy was associated with a reduced complication rate.
authors: Department of Neurosurgery, Fuji Brain Institute and Hospital , Shizuoka , Japan.
authors: Tomohiro
authors: T
authors: Inoue
authors: Akira
authors: A
authors: Tamura
authors: Kazuo
authors: K
authors: Tsutsumi
authors: Isamu
authors: I
authors: Saito
authors: Nobuhito
authors: N
authors: Saito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D002545:Brain Ischemia / Q000209:etiology / Q000601:surgery; D002341:Carotid Artery Thrombosis / Q000150:complications / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000502:physiology*; D038524:Diffusion Magnetic Resonance Imaging; D017128:Embolectomy / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D020521:Stroke / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome