Hybrid Surgical Rescue of Failed Stent Retrieval with Acute Middle Cerebral Artery Occlusion

Journal Pre-proof Hybrid surgical rescue of failed stent retrieval with acute middle cerebral artery occlusion Yihui Ma, MD, PhD, Dong Sun, MD, PhD, Shuguang Chen, BD, Xinjun Chen, MD, PhD PII:

S1878-8750(19)32755-X

DOI:

https://doi.org/10.1016/j.wneu.2019.10.127

Reference:

WNEU 13598

To appear in:

World Neurosurgery

Received Date: 20 August 2019 Revised Date:

20 October 2019

Accepted Date: 21 October 2019

Please cite this article as: Ma Y, Sun D, Chen S, Chen X, Hybrid surgical rescue of failed stent retrieval with acute middle cerebral artery occlusion, World Neurosurgery (2019), doi: https://doi.org/10.1016/ j.wneu.2019.10.127. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Elsevier Inc. All rights reserved.

Hybrid surgical rescue of failed stent retrieval with acute middle cerebral artery occlusion Yihui Ma, MD, PhD1*, Dong Sun, MD, PhD2, Shuguang Chen,BD1, Xinjun Chen, MD, PhD1#, 1

Department of Neurosurgery, Zhongnan Hospital of Wuhan University, 430000, Wuhan, China 2 Department of Neurology, Zhongnan Hospital of Wuhan University, 430000, Wuhan, China #

Corresponding Author: Xinjun Chen E-mail: [email protected] Failure of stent retrieval and periprocedural embolization of plaque are rare complications of carotid artery stenting (CAS), which need emergency surgical treatment. In this video, we demonstrated failed stent retrieval with acute middle cerebral artery occlusion that was treated with carotid endarterectomy (CEA) and stent-assisted thrombectomy (SAT) in a hybrid operating room. A 65-year-old man underwent CAS for symptomatic left internal carotid artery stenosis with severe calcification. Immediately after placement of the open-cell carotid stent, left middle cerebral artery (MCA) M1 segment occlusion was detected. A self-expanding retrievable intracranial stent was used for mechanical thrombectomy. However, the retrievable stent was blocked by the carotid stent and could not be retrieved. We attempted various ways to retrieve the device to avoid embolic complications including neck rotation, neck compression, but they all failed. Thus, we decided to perform surgical retrieval. Surgery was performed in a hybrid operating room under general anesthesia, and intraoperative neuromonitoring was used. The surgical field was deployed according to standard procedure. A longitudinal incision was then made through the adventitia on the anteriolateral surface of the carotid artery. We pulled both stents out of the vessel and mobilized the plaque from the adventitia. The arteriotomy is closed with a double 6/0 monofilament suture. Angiogram was performed after vessel suturing to confirm there was not vessel wall damage or flow problem. Following CEA, the stent-assisted thrombectomy (SAT) was perform. Postoperative digital subtraction angiography (DSA) confirmed the recanalization of MCA. The patient’s neurological function dramatically improved after hybrid treatment.

Abbreviations

CAS: carotid artery stenting CEA: carotid endarterectomy SAT: stent-assisted thrombectomy MCA: middle cerebral artery DSA: digital subtraction angiography