Microsurgical thrombectomy: where the ancient art meets the new era

Authors

Nakao Ota, Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, 3-1, Higashi 1, Kita 33, Higashi-Ku, Sapporo, Hokkaido, 065-0033, Japan. nakao1980@gmail.com.
Arnau Benet, Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, 3-1, Higashi 1, Kita 33, Higashi-Ku, Sapporo, Hokkaido, 065-0033, Japan.
Muhammad Kusdiansah, Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, 3-1, Higashi 1, Kita 33, Higashi-Ku, Sapporo, Hokkaido, 065-0033, Japan.
Norio Miyoshi, Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, 3-1, Higashi 1, Kita 33, Higashi-Ku, Sapporo, Hokkaido, 065-0033, Japan.
Kenichi Haraguchi, Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, 3-1, Higashi 1, Kita 33, Higashi-Ku, Sapporo, Hokkaido, 065-0033, Japan.
Kosumo Noda, Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, 3-1, Higashi 1, Kita 33, Higashi-Ku, Sapporo, Hokkaido, 065-0033, Japan.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA.
Rokuya Tanikawa, Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, 3-1, Higashi 1, Kita 33, Higashi-Ku, Sapporo, Hokkaido, 065-0033, Japan.

Document Type

Article

Abstract

Mechanical thrombectomy (MT) is the leading treatment for acute large vessel occlusion (LVO). However, surgical thrombectomy (ST) may have a role in well selected LVO patients where MT failed to re-establish flow, the endovascular route is inaccessible, or where MT is a financially prohibitive or absent option (developing and poor countries). We compared the efficacy and efficiency between ST and MT, and described our operative experience and its potential application in the developing world. Clinical outcomes, procedural times, and efficacy of treatment were compared between the MT and ST of acute LVO between 2012 and 2022. Propensity score-matched analysis was also conducted to compare MT and ST. One-hundred nine patients fulfilled the study criteria (77 MTs vs 32 STs). Factors driving outcome were age (aOR: 0.95, 95%CI, 0.91-0.98), hemisphere side (aOR: 0.38, 95%CI, 0.15-0.96), and DWI-ASPECT (aOR: 1.39, 95%CI, 1.09-1.77) at presentation by the multivariate analysis. Times from door-start of procedure (P = 0.45) and start of procedure-recanalization (P = 0.13) were similar between treatment options. Propensity score-matched analysis found no significant difference for 2 treatment methods about time of door to recanalization (P = 0.155) and outcome (P = 0.221). The prognosticators of thrombectomy for acute LVO in patients with successful recanalization were age, affected hemisphere side, and DWI-ASPECT score. Our evidence shows that the efficacy of ST is similar to that of MT. There should be a place of ST for cases of mechanical failure or tandem cervical ICA and MCA occlusion. ST may be a temporizing LVO treatment option in healthcare systems where MT is inexistent or financially prohibitive to patients.

Medical Subject Headings

Humans; Thrombectomy; Multivariate Analysis; Propensity Score

Publication Date

1-15-2024

Publication Title

Neurosurgical review

E-ISSN

1437-2320

Volume

47

Issue

1

First Page

49

PubMed ID

38224379

Digital Object Identifier (DOI)

10.1007/s10143-024-02281-8

Recommended Citation

Ota, Nakao; Benet, Arnau; Kusdiansah, Muhammad; Miyoshi, Norio; Haraguchi, Kenichi; Noda, Kosumo; Lawton, Michael T.; and Tanikawa, Rokuya, "Microsurgical thrombectomy: where the ancient art meets the new era" (2024). Neurosurgery. 2013.
https://scholar.barrowneuro.org/neurosurgery/2013