title: Direct Microsurgical Embolectomy for Acute Occlusion of the Internal Carotid Artery and Middle Cerebral Artery.
abstract: BACKGROUND
  Surgical embolectomy is the most promising therapy for physically removing emboli from major cerebral arteries. However, it requires an experienced surgical team, time-consuming steps, and is not incorporated into acute stroke therapy.
  
  
  METHODS
  We established seamless collaboration between services, refined surgical techniques, and conducted a prospective trial of emergency surgical embolectomy. Surgical indications included the presence of acute hemispheric symptoms, absence of low-density area on computed tomography, evidence of internal carotid artery terminus or proximal middle cerebral artery occlusion, and availability of resources to start surgery within 3 hours of symptom onset. The indications were confirmed by an interdisciplinary team. We assessed revascularization rates, time from admission to surgery and from surgery to recanalization, procedural complications, and clinical outcomes.
  
  
  RESULTS
  Between 2005 and 2014, 14 consecutive patients with acute proximal middle cerebral artery or internal carotid artery terminus occlusion underwent emergency surgical embolectomy. All patients showed complete recanalization. Twelve patients survived and 7 had fair functional outcome (Rankin Scale score, ≤3). No significant procedural adverse events occurred. The mean times from admission to start of surgery, from surgery to recanalization, and from onset to recanalization were 14 minutes, 79 minutes, and 223 minutes, respectively.
  
  
  CONCLUSIONS
  Our results suggest that microsurgical embolectomy can rapidly, safely, and effectively retrieve clots and deserves reappraisal, although the choice largely depends on local institutional expertise.
authors.affiliation: Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto, Japan. Electronic address: hinolab2@yahoo.co.jp.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Hino
authors.affiliation: Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Oka
authors.affiliation: Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto, Japan.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Echigo
authors.affiliation: Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Koseki
authors.affiliation: Department of Neurology, Saiseikai Shigaken Hospital, Ritto, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Fujii
authors.affiliation: Department of Radiology, Saiseikai Shigaken Hospital, Ritto, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Katsumori
authors.affiliation: Department of Emergency and Critical Care Center, Saiseikai Shigaken Hospital, Ritto, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Shiomi
authors.affiliation: Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nozaki
authors.affiliation: Center of Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan.
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.affiliation: Department of Neurosurgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Hashimoto
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016893:Carotid Stenosis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D015897:Comorbidity; D017128:Embolectomy / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D007564:Japan / Q000453:epidemiology; D008297:Male; D061646:Operative Time; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute stroke; Embolectomy; Internal carotid artery; Middle cerebral artery; Surgery