Emergent microsurgical intervention for acute stroke after mechanical thrombectomy failure: a prospective study.
J Neurointerv Surg
; 15(5): 439-445, 2023 May.
Article
en En
| MEDLINE
| ID: mdl-35428739
ABSTRACT
BACKGROUND:
Despite all the gains that have been achieved with endovascular mechanical thrombectomy revascularization and intravenous thrombolysis logistics since 2015, there is still a subgroup of patients with salvageable brain tissue for whom persistent emergent large vessel occlusion portends a catastrophic outcome.OBJECTIVE:
To test the safety and efficacy of emergent microsurgical intervention in patients with acute ischemic stroke and symptomatic middle cerebral artery occlusion after failure of mechanical thrombectomy.METHODS:
A prospective two-center cohort study was conducted. Patients with acute ischemic stroke and middle cerebral artery occlusion for whom recanalization failed at center 1 were randomly allocated to the microsurgical intervention group (MSIG) or control group 1 (CG1). All similar patients at center 2 were included in the control group 2 (CG2) with no surgical intervention. Microsurgical embolectomy and/or extracranial-intracranial bypass was performed in all MSIG patients at center 1.RESULTS:
A total of 47 patients were enrolled in the study 22 at center 1 (12 allocated to the MSIG and 10 to the CG1) and 25 patients at center 2 (CG2). MSIG group patients showed a better clinical outcome on day 90 after the stroke, where a modified Rankin Scale score of 0-2 was reached in 7 (58.3%) of 12 patients compared with 1/10 (10.0%) patients in the CG1 and 3/12 (12.0%) in the CG2.CONCLUSIONS:
This study demonstrated the potential for existing microsurgical techniques to provide good outcomes in 58% of microsurgically treated patients as a third-tier option.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Isquemia Encefálica
/
Accidente Cerebrovascular
/
Procedimientos Endovasculares
/
Accidente Cerebrovascular Isquémico
Tipo de estudio:
Observational_studies
Límite:
Humans
Idioma:
En
Año:
2023
Tipo del documento:
Article