İskemik serebrovasküler patolojilerde cerrahi embolektomi veya by-pass cerrahisi ilk tedavi seçeneği olabilir mi?
Abstract
Amaç: İntraserebral damar tıkanıklıklarında tıbbi trombolitik tedaviler, endovasküler girişimler ve cerrahi işlemler dahil olmak üzere köklü tedavi yöntemleri kullanılmaktadır.
Yöntemler: Bu çalışmada, cerrahi rekanalizasyon tekniklerine odaklanıldı ve bunlar altı vaka aracılığıyla ortaya kondu. Hastanemizde acil koşullarda tromboembolik olay yaşayan iki hastaya geç dönem tromboembolektomi uygulandı. Diğer iki hasta, acil şartlarda değil, ertesi hafta by-pass ameliyatıyla tedavi altına alındı. Son iki hasta ise klinik semptomlu kronik iskemik intraserebral süreçler nedeniyle rekanalizasyon cerrahisi ile reperfüzyon uygulanan hasta grubundaydı.
Bulgular: İlk hasta, diğer tedavi yaklaşımlarına yanıt vermeyen internal karotid arter (İKA) total enfarktüsü nedeniyle ameliyat edildi. Benzer şekilde kalp nakli sonrası emboli atan ikinci hastada da trombolitik tedavilerin başarısız olması sonucu ana arterlerden kaynaklanan küçük aterom plaklarının düzelmemesi nedeniyle ameliyat edilmesi gerekti. Her iki durumda da başarılı rekanalizasyon prosedürleri sağlandı.
İvedi koşullarda ameliyata alınan hastalar içerisinde biri, travma sonrası internal karotis arter yetmezliği, bir diğeri vasküler hastalık sonrası sol serebral hemisferin beslenmesinin bozulması, ve son iki hasta da anevrizma kaynaklı trombüs sebebiyle ana vasküler arterlerin tıkanması sebebiyle opere edildi.
Sonuç: Bulgularımız, seçilmiş vakalarda akut inmenin tedavisinde cerrahi müdahalenin birincil tedavi seçeneği olarak düşünülebileceğini göstermektedir. Seçilmiş hastalarda hızlı ve ilk seçenek olarak cerrahi tedavi yüz güldürücüdür. Bu yaklaşım, farklı intraserebral damar tıkanıklığı senaryolarında en uygun yaklaşımı belirlemek için daha kapsamlı araştırmalara ihtiyaç olduğunu göstermektedir.
References
- Inoue T, Tamura A, Tsutsumi K, Saito I, Saito N. Surgical embolectomy for large vessel occlusion of anterior circulation. Br J Neurosurg. 2013;27(6):783-790. doi:10.3109/02688697.2013.793286
- Horiuchi T, Nitta J, Miyaoka Y, et al. Open embolectomy of large vessel occlusion in the endovascular era: results of a 12-Year single-center experience. World Neurosurg. 2017;102:65-71. doi:10.1016/j.wneu.2017.02.108
- Rabinstein AA. Update on treatment of acute ischemic stroke. Continuum (Minneap Minn). 2020;26(2):268-286. doi:10.1212/CON.0000000000000840
- Kang R, Gamdzyk M, Tang H, Luo Y, Lenahan C, Zhang JH. Delayed recanalization-how late is not too late?. Transl Stroke Res. 2021;12(3):382-393. doi:10.1007/s12975-020-00877-y
- Yao YD, Liu AF, Qiu HC, et al. Outcomes of late endovascular recanalization for symptomatic non-acute atherosclerotic intracranial large artery occlusion. Clin Neurol Neurosurg. 2019;187:105567. doi:10.1016/j.clineuro.2019.105567
- Nogueira RG, Ribó M. Endovascular treatment of acute stroke. Stroke. 2019;50(9):2612-2618. doi:10.1161/STROKEAHA.119.023811
- Pilgram-Pastor SM, Piechowiak EI, Dobrocky T, et al. Stroke thrombectomy complication management. J Neurointerv Surg. 2021;13(10):912-917. doi:10.1136/neurintsurg-2021-017349
- Derex L, Cho TH. Mechanical thrombectomy in acute ischemic stroke. Revue Neurologique. 2017;173(3):106-113.
- Jadhav AP, Desai MS, Jovin GT. Indications for mechanical thrombectomy for acute ischemic stroke: current guidelines and beyond. Neurology. 2021;97(20 Suppl 2): S126-S136.
- Campbell BC. Thrombolysis and thrombectomy for acute ischemic stroke: strengths and synergies. Semin Thromb Hemost. 2017;43(2):185-190.
- Choi JH, Im SH, Lee KJ, Koo JS, Kim BS, Shin YS. Comparison of outcomes after mechanical thrombectomy alone or combined with intravenous thrombolysis and mechanical thrombectomy for patients with acute ischemic stroke due to large vessel occlusion. World Neurosurg. 2018;114:e165-e172. doi:10.1016/j.wneu.2018.02.126
- Mathias K. Acute stroke: balloon-tipped catheter in thrombectomy. J Cardiovasc Surg. 2016;57(1):48-51
- Qureshi A, Singh B, Huang W, Du Z, Lobanova I, Liaqat J. Mechanical thrombectomy in acute ischemic stroke patients performed within and outside clinical trials in the United States. Neurosurgery. 2020;86(1):E2-E8.
- Wang A, Abramowicz AE. Endovascular thrombectomy in acute ischemic stroke: new treatment guide. Curr Opin Anaesthesiol. 2018;31(4):473-480.
- Doğan AG. The effect of occupational therapy on upper extremity function and activities of daily living in hemiplegic patients. J Med Palliat Care. 2023;4(4):350-354.
- Herpich F, Rincon F. Management of acute ischemic stroke. Crit Care Med. 2020;48(11):1654-1663. doi:10.1097/CCM. 0000000000004597
- Green TL, McNair ND, Hinkle JL, et al. Care of the patient with acute ischemic stroke (posthyperacute and prehospital discharge): update to 2009 comprehensive nursing care scientific statement: a scientific statement from the American Heart Association. Stroke. 2021;52(5):e179-e197. doi:10.1161/STR.0000000000000357
- Jolugbo P, Ariëns RAS. Thrombus composition and efficacy of thrombolysis and thrombectomy in acute ischemic stroke. Stroke. 2021;52(3):1131-1142. doi:10.1161/STROKEAHA.120.032810
- Nie X, Leng X, Miao Z, Fisher M, Liu L. Clinically ineffective reperfusion after endovascular therapy in acute ischemic stroke. Stroke. 2023;54(3):873-881. doi:10.1161/STROKEAHA.122.038466
- Rha JH, Shrivastava VP, Wang Y, et al. Thrombolysis for acute ischaemic stroke with alteplase in an Asian population: results of the multicenter, multinational Safe Implementation of Thrombolysis in Stroke-Non-European Union World (SITS-NEW). Int J Stroke. 2014;9 Suppl A100:93-101. doi:10.1111/j.1747-4949.2012.00895.x
Can surgical embolectomy or by-pass surgery be the first treatment option in ischemic cerebrovascular pathologies?
Abstract
Background: Well-established treatment methods have been utilized for intracerebral vascular occlusion, including medical thrombolytic treatments, endovascular interventions, and surgical procedures.
Methods: This study focused on surgical recanalization techniques, illustrating them through six patients. In emergency scenarios at our hospital, late-term thromboembolectomy was performed on two patients who had experienced thromboembolic events.The other two patients were treated not in emergency conditions, but with by-pass surgery in the following week.Last two patients were in the group of patients who had reperfusion with recanalization surgery due to chronic ischemic intracerebral processes with clinical symptoms.
Results: One of the patient underwent emergency surgery for total infarction of the internal carotid artery (ICA), which remained unresponsive to other therapeutic approaches. Similarly, the second patient, who had undergone heart transplantation, required surgery due to unyielding small atheroma plaques originating from the main arteries after failed thrombolytic treatments. Successful recanalization procedures were achieved in both cases. Among the other patients who underwent semi-emergency surgery, one patient with internal carotid artery insufficiency after a traumatic process, another patient with left hemisphere vascular insufficiency after vascular disease, and another two patients who had vascular insufficiency due to occlusion of the main vascular structure by an aneurysm thrombus were operated on.
Conclusions: Our findings suggest that surgical intervention could be considered as the primary treatment option in selected cases for managing acute stroke or vascular insufficiency. In selected patients, rapid and first-line surgical treatment is satisfactory. This approach aligns with the need for more comprehensive investigations to determine the optimal approach in different scenarios of intracerebral vascular occlusion.
References
- Inoue T, Tamura A, Tsutsumi K, Saito I, Saito N. Surgical embolectomy for large vessel occlusion of anterior circulation. Br J Neurosurg. 2013;27(6):783-790. doi:10.3109/02688697.2013.793286
- Horiuchi T, Nitta J, Miyaoka Y, et al. Open embolectomy of large vessel occlusion in the endovascular era: results of a 12-Year single-center experience. World Neurosurg. 2017;102:65-71. doi:10.1016/j.wneu.2017.02.108
- Rabinstein AA. Update on treatment of acute ischemic stroke. Continuum (Minneap Minn). 2020;26(2):268-286. doi:10.1212/CON.0000000000000840
- Kang R, Gamdzyk M, Tang H, Luo Y, Lenahan C, Zhang JH. Delayed recanalization-how late is not too late?. Transl Stroke Res. 2021;12(3):382-393. doi:10.1007/s12975-020-00877-y
- Yao YD, Liu AF, Qiu HC, et al. Outcomes of late endovascular recanalization for symptomatic non-acute atherosclerotic intracranial large artery occlusion. Clin Neurol Neurosurg. 2019;187:105567. doi:10.1016/j.clineuro.2019.105567
- Nogueira RG, Ribó M. Endovascular treatment of acute stroke. Stroke. 2019;50(9):2612-2618. doi:10.1161/STROKEAHA.119.023811
- Pilgram-Pastor SM, Piechowiak EI, Dobrocky T, et al. Stroke thrombectomy complication management. J Neurointerv Surg. 2021;13(10):912-917. doi:10.1136/neurintsurg-2021-017349
- Derex L, Cho TH. Mechanical thrombectomy in acute ischemic stroke. Revue Neurologique. 2017;173(3):106-113.
- Jadhav AP, Desai MS, Jovin GT. Indications for mechanical thrombectomy for acute ischemic stroke: current guidelines and beyond. Neurology. 2021;97(20 Suppl 2): S126-S136.
- Campbell BC. Thrombolysis and thrombectomy for acute ischemic stroke: strengths and synergies. Semin Thromb Hemost. 2017;43(2):185-190.
- Choi JH, Im SH, Lee KJ, Koo JS, Kim BS, Shin YS. Comparison of outcomes after mechanical thrombectomy alone or combined with intravenous thrombolysis and mechanical thrombectomy for patients with acute ischemic stroke due to large vessel occlusion. World Neurosurg. 2018;114:e165-e172. doi:10.1016/j.wneu.2018.02.126
- Mathias K. Acute stroke: balloon-tipped catheter in thrombectomy. J Cardiovasc Surg. 2016;57(1):48-51
- Qureshi A, Singh B, Huang W, Du Z, Lobanova I, Liaqat J. Mechanical thrombectomy in acute ischemic stroke patients performed within and outside clinical trials in the United States. Neurosurgery. 2020;86(1):E2-E8.
- Wang A, Abramowicz AE. Endovascular thrombectomy in acute ischemic stroke: new treatment guide. Curr Opin Anaesthesiol. 2018;31(4):473-480.
- Doğan AG. The effect of occupational therapy on upper extremity function and activities of daily living in hemiplegic patients. J Med Palliat Care. 2023;4(4):350-354.
- Herpich F, Rincon F. Management of acute ischemic stroke. Crit Care Med. 2020;48(11):1654-1663. doi:10.1097/CCM. 0000000000004597
- Green TL, McNair ND, Hinkle JL, et al. Care of the patient with acute ischemic stroke (posthyperacute and prehospital discharge): update to 2009 comprehensive nursing care scientific statement: a scientific statement from the American Heart Association. Stroke. 2021;52(5):e179-e197. doi:10.1161/STR.0000000000000357
- Jolugbo P, Ariëns RAS. Thrombus composition and efficacy of thrombolysis and thrombectomy in acute ischemic stroke. Stroke. 2021;52(3):1131-1142. doi:10.1161/STROKEAHA.120.032810
- Nie X, Leng X, Miao Z, Fisher M, Liu L. Clinically ineffective reperfusion after endovascular therapy in acute ischemic stroke. Stroke. 2023;54(3):873-881. doi:10.1161/STROKEAHA.122.038466
- Rha JH, Shrivastava VP, Wang Y, et al. Thrombolysis for acute ischaemic stroke with alteplase in an Asian population: results of the multicenter, multinational Safe Implementation of Thrombolysis in Stroke-Non-European Union World (SITS-NEW). Int J Stroke. 2014;9 Suppl A100:93-101. doi:10.1111/j.1747-4949.2012.00895.x
Details
| Primary Language | English |
|---|---|
| Subjects | Brain and Nerve Surgery (Neurosurgery) |
| Journal Section | Research Articles [en] Araştırma Makaleleri [tr] |
| Authors | |
| Early Pub Date | October 26, 2023 |
| Publication Date | October 27, 2023 |
| Published in Issue | Year 2023 Volume: 4 Issue: 5 |
TR DİZİN ULAKBİM and International Indexes (1d)
Interuniversity Board (UAK) Equivalency: Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]
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