Horiuchi Tetsuyoshi, Nitta Junpei, Sakai Keiichi, Tanaka Yuichiro, Hongo Kazuhiro
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
J Neurosurg. 2007 Feb;106(2):257-62. doi: 10.3171/jns.2007.106.2.257.
The authors evaluated the efficacy of emergency embolectomy in patients with acute middle cerebral artery occlusion (MCAO).
A retrospective review of the charts for patients undergoing embolectomy at the authors' institution was performed. Between October 1997 and May 2004, 12 patients (mean age 70 years) with acute MCAO were treated using embolectomy. Local intraarterial fibrinolysis with urokinase was initially undertaken in eight of 12 patients. Sufficient recanalization was not achieved with fibrinolysis in any patient, and thus embolectomy was performed immediately thereafter. Recanalization by embolectomy was achieved in all patients (mean occlusion time 6 hours, 11 minutes). Each patient's condition was evaluated on discharge. Outcomes in the 12 patients according to the Glasgow Outcome Scale were good recovery in five, moderate disability in two, severe disability in three, vegetative state in one, and death due to a cardiac complication in one. None of the 12 patients had symptomatic hemorrhagic infarction.
Emergency embolectomy can be performed in patients with MCAO with minimal morbidity and death. The procedure can be used to achieve good recovery even in patients in whom fibrinolysis is insufficient after acute MCAO and should be a part of the algorithm for the treatment of MCAO.
作者评估了急诊取栓术治疗急性大脑中动脉闭塞（MCAO）患者的疗效。
对作者所在机构接受取栓术患者的病历进行回顾性分析。1997年10月至2004年5月期间，12例急性MCAO患者（平均年龄70岁）接受了取栓术治疗。12例患者中有8例最初采用尿激酶局部动脉内溶栓治疗。所有患者溶栓后均未实现充分再通，因此随后立即进行了取栓术。所有患者均通过取栓术实现了再通（平均闭塞时间6小时11分钟）。对每位患者出院时的情况进行评估。根据格拉斯哥预后量表，12例患者的预后情况为：5例恢复良好，2例中度残疾，3例重度残疾，1例植物状态，1例因心脏并发症死亡。12例患者均未出现症状性出血性梗死。
急诊取栓术可用于MCAO患者，且发病率和死亡率极低。即使在急性MCAO后溶栓不足的患者中，该手术也可实现良好恢复，应成为MCAO治疗方案的一部分。
