Keles Abdullah, Uyaniker Zeynep Arzum, Aagaard-Kienitz Beverly, Baskaya Mustafa K
Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA.
Brain Sci. 2024 Aug 30;14(9):882. doi: 10.3390/brainsci14090882.
Rapid identification of the type and origin of a stroke is crucial for prompt and appropriate treatment, which can significantly influences patient outcomes. We report a multidisciplinary management case involving a 76-year-old man who presented with left-sided weakness and mild dysarthria. Imaging revealed a completely occluded right internal carotid artery. Despite multiple endovascular recanalization attempts, adequate flow could not be achieved, leading to the decision to perform an open thrombo-endarterectomy. The patient underwent carotid endarterectomy with microsurgical techniques under general anesthesia. The atheroma plaque and central thrombus were removed, which reestablished flow. Continuous intraoperative neuromonitoring was utilized to ensure patient safety. The patient woke up without new deficits and was discharged for rehabilitation. Follow-up imaging confirmed arterial patency, and the patient eventually made an excellent recovery, including being independent over one and a half years. Emergent recanalization with carotid endarterectomy following a failed endovascular recanalization is both safe and feasible, emphasizing the need for collaboration between different treatment providers to ensure optimal patient outcomes. Our report highlights the importance of a multidisciplinary approach and the advantages of a hybrid operating room in the treatment of acute complete carotid artery occlusion.
快速识别中风的类型和起源对于及时、恰当的治疗至关重要，这会显著影响患者的预后。我们报告了一例多学科管理病例，患者为一名76岁男性，表现为左侧肢体无力和轻度构音障碍。影像学检查显示右侧颈内动脉完全闭塞。尽管多次尝试血管内再通，但未能实现足够的血流，因此决定进行开放性血栓内膜切除术。患者在全身麻醉下采用显微外科技术接受了颈动脉内膜切除术。去除了动脉粥样硬化斑块和中央血栓，恢复了血流。术中持续进行神经监测以确保患者安全。患者醒来后没有出现新的神经功能缺损，随后出院进行康复治疗。随访影像学检查证实动脉通畅，患者最终恢复良好，包括在一年半多的时间里能够独立生活。血管内再通失败后紧急进行颈动脉内膜切除术进行再通是安全可行的，这强调了不同治疗团队之间合作以确保患者获得最佳预后的必要性。我们的报告强调了多学科方法的重要性以及杂交手术室在治疗急性颈内动脉完全闭塞中的优势。
