Direct Neck Exposure for Rescue Endovascular Mechanical Thrombectomy in a Patient with Acute Common Carotid Occlusion Concurrent with Type A Aortic Dissection.

BACKGROUND: Mechanical thrombectomy is an effective treatment of acute large vessel occlusion. However, when difficult anatomy is encountered in which the reperfusion catheter cannot be positioned well, the outcomes can be suboptimal. We present a patient with right common carotid artery (CCA) and internal carotid artery occlusion after repair of an acute type A aortic dissection. Successful mechanical thrombectomy and stenting through direct neck exposure and puncture was performed. CASE DESCRIPTION: A 45-year-old man with a type A aortic dissection presented with sudden onset of neck pain and cold sweating. Aortic valve resuspension, proximal anastomosis of ascending aortic graft, partial aortic arch graft replacement, and innominate artery reimplantation was performed. After aortic surgery, left limb weakness was noted in the intensive care unit. Computed tomography angiography of the brain showed right CCA occlusion up to the internal carotid artery. The right CCA was exposed and directly punctured. A thrombus was successfully removed, and 5 stents were deployed to treat the internal carotid artery and CCA dissection. Angiography showed a final Thrombolysis In Cerebral Infarction 3 result, and the patient had an excellent clinical recovery. CONCLUSIONS: Acute mechanical thrombectomy through open direct neck puncture to treat an acute type A aortic dissection and concurrent CCA dissection and occlusion is an effective and optimal method.

Postcranioplasty seizures following decompressive craniectomy and seizure prophylaxis: a retrospective analysis at a single institution.

OBJECTIVE: Cranioplasty is a relatively simple and less invasive intervention, but it is associated with a high incidence of postoperative seizures. The incidence of, and the risk factors for, such seizures and the effect of prophylactic antiepileptic drugs (AEDs) have not been well studied. The authors' aim was to evaluate the risk factors that predispose patients to postcranioplasty seizures and to examine the role of seizure prophylaxis in cranioplasty. METHODS: The records of patients who had undergone cranioplasty at the authors' medical center between 2009 and 2014 with at last 2 years of follow-up were retrospectively reviewed. Demographic and clinical characteristics, the occurrence of postoperative seizures, and postoperative complications were analyzed. RESULTS: Among the 583 patients eligible for inclusion in the study, 247 had preexisting seizures or used AEDs before the cranioplasty and 336 had no seizures prior to cranioplasty. Of these 336 patients, 89 (26.5%) had new-onset seizures following cranioplasty. Prophylactic AEDs were administered to 56 patients for 1 week after cranioplasty. No early seizures occurred in these patients, and this finding was statistically significant (p = 0.012). Liver cirrhosis, intraoperative blood loss, and shunt-dependent hydrocephalus were risk factors for postcranioplasty seizures in the multivariable analysis. CONCLUSIONS: Cranioplasty is associated with a high incidence of postoperative seizures. The prophylactic use of AEDs can reduce the occurrence of early seizures.