• Akihiko Hino, Hideki Oka, Youichi Hashimoto, Tadashi Echigo, Hirokazu Koseki, Akihiro Fujii, Tetsuya Katsumori, Naoto Shiomi, Kazuhiko Nozaki, Hisatomi Arima, and Naoya Hashimoto.
• Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto, Japan. Electronic address: hinolab2@yahoo.co.jp.
• World Neurosurg. 2016 Apr 1; 88: 243-251.

BackgroundSurgical embolectomy is the most promising therapy for physically removing emboli from major cerebral arteries. However, it requires an experienced surgical team, time-consuming steps, and is not incorporated into acute stroke therapy.MethodsWe established seamless collaboration between services, refined surgical techniques, and conducted a prospective trial of emergency surgical embolectomy. Surgical indications included the presence of acute hemispheric symptoms, absence of low-density area on computed tomography, evidence of internal carotid artery terminus or proximal middle cerebral artery occlusion, and availability of resources to start surgery within 3 hours of symptom onset. The indications were confirmed by an interdisciplinary team. We assessed revascularization rates, time from admission to surgery and from surgery to recanalization, procedural complications, and clinical outcomes.ResultsBetween 2005 and 2014, 14 consecutive patients with acute proximal middle cerebral artery or internal carotid artery terminus occlusion underwent emergency surgical embolectomy. All patients showed complete recanalization. Twelve patients survived and 7 had fair functional outcome (Rankin Scale score, ≤3). No significant procedural adverse events occurred. The mean times from admission to start of surgery, from surgery to recanalization, and from onset to recanalization were 14 minutes, 79 minutes, and 223 minutes, respectively.ConclusionsOur results suggest that microsurgical embolectomy can rapidly, safely, and effectively retrieve clots and deserves reappraisal, although the choice largely depends on local institutional expertise.Copyright © 2016 Elsevier Inc. All rights reserved.

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