Embolectomy for acute embolic occlusion of the internal carotid artery bifurcation

BACKGROUND Acute occlusion of the distal intracranial segment of the intern al carotid artery (ICA) causes sudden severe hemispheric ischemia. A low ra te of recanalization and a high mortality rate for this condition have been noted, even with endovascular treatment. METHODS We report the results of emergency embolectomy in six patients with acute embolic occlusion of the internal carotid artery (ICA) bifurcation. All six patients were admitted to our institute within 2 h of the onset of symptoms. Computed tomography (CT) scans on admission revealed no low-densi ty or high-density regions in any patients. The time between onset of sympt oms and completion of angiography ranged from 2 to 4 h (2.8 +/- 0.7 h). RESULTS Emergency embolectomy was performed for each patient. Recanalizatio n was confirmed angiographically in four of the patients. In the remaining two patients, massive infarction in the territory of the ICA was detected o n the CT scans obtained the day of the operation, and postoperative angiogr aphy was not performed in these two cases. These two patients died of uncal herniation 6 days after onset. Two of the six patients were able to walk w ith a cane 2 months after surgery. The remaining two patients were unable t o walk or attend to their own bodily needs without assistance. The time ela psed between onset of symptoms to reopening of the occluded vessel was with in 6 h in the four surviving patients. The recanalization rate was 66.7% (4 /6) for the embolectomy procedure, significantly higher than that (12.5%) o f the thrombolytic therapy reported in a previous study. CONCLUSIONS In summary, open embolectomy can be performed when the time aft er onset of symptoms is less than 6 h. (C) 1999 by Elsevier Science Inc.