title: Surgical embolectomy for middle cerebral artery occlusion after thrombolytic therapy: A report of two cases.
abstract: BACKGROUND
  Occlusion of the intracranial main trunk results in a poor functional outcome and a high mortality rate. Accordingly, some revascularization procedures such as intravenous administration of recombinant tissue plasminogen activator (rt-PA), endovascular surgery, or surgical embolectomy in the very acute stage have been attempted.
  
  
  METHODS
  We describe two patients with middle cerebral artery occlusion due to cardiogenic embolism. One patient was subjected to surgical embolectomy shortly after intravenous rt-PA and the other was subjected to same after intra-arterial urokinase. Complete recanalization without new cerebral infarction territory was achieved in both patients.
  
  
  CONCLUSIONS
  Based on our experience, we think that surgical embolectomy is an effective and safe procedure and should be attempted when no response to early thrombolytic therapy is obtained.
authors.affiliation: Department of Neurosurgery, Abashiri Neurosurgical and Rehabilitation Hospital, Abashiri, Hokkaido, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Katsuno
authors.affiliation: Department of Neurosurgery, Abashiri Neurosurgical and Rehabilitation Hospital, Abashiri, Hokkaido, Japan.
authors.forename: Kazutsune
authors.initials: K
authors.lastname: Kawasaki
authors.affiliation: Department of Neurosurgery, Abashiri Neurosurgical and Rehabilitation Hospital, Abashiri, Hokkaido, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Izumi
authors.affiliation: Department of Neurosurgery, Abashiri Neurosurgical and Rehabilitation Hospital, Abashiri, Hokkaido, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hashimoto
keywords: Cerebral infarction; middle cerebral artery; surgical embolectomy