Emergent microsurgical intervention for acute stroke after mechanical thrombectomy failure: a prospective study
Jazyk angličtina Země Anglie, Velká Británie Médium print-electronic
Typ dokumentu randomizované kontrolované studie, časopisecké články
PubMed
35428739
PubMed Central
PMC10176344
DOI
10.1136/neurintsurg-2022-018643
PII: neurintsurg-2022-018643
Knihovny.cz E-zdroje
- Klíčová slova
- Stroke, Thrombectomy, Thrombolysis,
- MeSH
- arteria carotis interna chirurgie MeSH
- cévní mozková příhoda * diagnostické zobrazování chirurgie MeSH
- endovaskulární výkony * metody MeSH
- infarkt arteria cerebri media MeSH
- ischemická cévní mozková příhoda * MeSH
- ischemie mozku * diagnostické zobrazování chirurgie MeSH
- kohortové studie MeSH
- lidé MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- trombektomie škodlivé účinky metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
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.
Department of Neurology Nemocnice České Budějovice České Budějovice Jihočeský Czech Republic
Department of Neurology University Hospital Ostrava Ostrava Moravskoslezský Czech Republic
Department of Neurosurgery Nemocnice České Budějovice České Budějovice Jihočeský Czech Republic
Department of Neurosurgery Univerzita Karlova Lékařská fakulta v Plzni Plzeň Plzeňský Czech Republic
Department of Radiology University Hospital Ostrava Ostrava Moravskoslezský Czech Republic
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