Turkish Neurosurgery
Mechanical thrombectomy for acute cardiogenic internal carotid artery occlusion with cross-flow through the communicating artery
Seigo Kimura1, Ryokichi Yagi2, Fumihisa Kishi1, Ryo Tamaki3, Daiji Ogawa1, Keiichi Yamada1, Hirokatsu Taniguchi1, Masahiko Wanibuchi2
1Kouzenkai Yagi Neurosurgical Hospital, Department of Neurosurgery, Osaka,
2Osaka Medical and Pharmaceutical University Hospital, Department of Neurosurgery and Endovascular Therapy, Takatsuki,
3Osaka General Medical Center, Department of Neurosurgery, Osaka,
DOI: 10.5137/1019-5149.JTN.45181-23.3

Aim:This study reports mechanical thrombectomy (MT) for internal carotid artery (ICA) occlusion with cross-flow through the communicating artery (“with” group) and compares it to ICA or middle cerebral artery occlusion without cross-flow (“without” group).Material and Methods:This study included 10 and 57 cases of the “with” and “without” groups, respectively. Cases analyzed by rapid processing of perfusion and diffusion (RAPID) since October 2020 were included.Results:Puncture-to-reperfusion time was 78.5 and 39 min (p = 0.0155), the National Institutes of Health Stroke Scale score at discharge was 10.5 and 4 (p = 0.0166), decline from pre to post Diffusion-Weighted Image-Alberta Stroke Program Early CT Score was 0.5 and 0 (p =0.0495), and the modified Rankin Scale score at 90 days was 4 and 2 (p = 0.0195) in the “with” and “without” groups, respectively. Furthermore, Tmax values of >6 s (50 cc vs. 164 cc; p = 0.0277) and Tmax >4 s/Tmax > 6 s ratio (3.23 vs. 1.55) (p = 0.0074) were significantly different between the “with” and “without” groups.Conclusion:The “with” group may have been affected by the longer treatment time and being at high risk of distal migration of thrombus due to poor prognosis. Although the region with a Tmax of >6 s tends to be small in patients of the “with” group, it indicates a low-perfusion state that can lead to cerebral infarction, and MT should be performed.

Corresponding author : Seigo Kimura