İskemik serebrovasküler patolojilerde cerrahi embolektomi veya by-pass cerrahisi ilk tedavi seçeneği olabilir mi?

Abstract

Background: Well-established treatment methods have been utilized for intracerebral vascular occlusion, including medical thrombolytic treatments, endovascular interventions, and surgical procedures. Methods: This study focused on surgical recanalization techniques, illustrating them through six patients. In emergency scenarios at our hospital, late-term thromboembolectomy was performed on two patients who had experienced thromboembolic events.The other two patients were treated not in emergency conditions, but with by-pass surgery in the following week.Last two patients were in the group of patients who had reperfusion with recanalization surgery due to chronic ischemic intracerebral processes with clinical symptoms. Results: One of the patient underwent emergency surgery for total infarction of the internal carotid artery (ICA), which remained unresponsive to other therapeutic approaches. Similarly, the second patient, who had undergone heart transplantation, required surgery due to unyielding small atheroma plaques originating from the main arteries after failed thrombolytic treatments. Successful recanalization procedures were achieved in both cases. Among the other patients who underwent semi-emergency surgery, one patient with internal carotid artery insufficiency after a traumatic process, another patient with left hemisphere vascular insufficiency after vascular disease, and another two patients who had vascular insufficiency due to occlusion of the main vascular structure by an aneurysm thrombus were operated on. Conclusions: Our findings suggest that surgical intervention could be considered as the primary treatment option in selected cases for managing acute stroke or vascular insufficiency. In selected patients, rapid and first-line surgical treatment is satisfactory. This approach aligns with the need for more comprehensive investigations to determine the optimal approach in different scenarios of intracerebral vascular occlusion.