Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
Neurosurg Rev. 2024 Oct 16;47(1):800. doi: 10.1007/s10143-024-03031-6.
Surgical thrombectomy remains a feasible technique in an accurately selected patient population with large vessel occlusion, even though endovascular mechanical thrombectomy is the gold standard. It especially warrants consideration in cases where the endovascular approach is unfeasible or fails. The current extension in the therapeutic window of time in mechanical thrombectomy also provides opportunities to open thrombectomy. To support our view, we present a case of a patient who suffered an ischemic stroke. Intravenous thrombolysis proved ineffective and mechanical thrombectomy was impossible due to extreme tortuosity of the internal carotid artery. Therefore, surgical thrombectomy was performed. The patient underwent successful recovery and states a great satisfaction. To improve efficiency and outcomes, a properly organised and trained surgical team with plentiful neurovascular experience is necessary. Finally, open thrombectomy is the most effective approach to completely restore luminal patency compared to the endovascular approaches yet risks due to the operation should be taken into account.
在大血管闭塞的精确选择的患者人群中，手术血栓切除术仍然是一种可行的技术，尽管血管内机械血栓切除术是金标准。在血管内方法不可行或失败的情况下，尤其需要考虑这种方法。机械血栓切除术的治疗时间窗的当前延长也为血栓切除术提供了机会。为了支持我们的观点，我们提出了一个患有缺血性中风的患者的病例。静脉溶栓治疗无效，由于颈内动脉极度迂曲，机械血栓切除术也无法进行。因此，进行了手术血栓切除术。患者成功恢复，并且非常满意。为了提高效率和结果，需要有一个组织良好且训练有素的、具有丰富神经血管经验的手术团队。最后，与血管内方法相比，开放血栓切除术是恢复管腔通畅的最有效方法，但由于手术风险，应予以考虑。
