J Clin Neurol.  2011 Sep;7(3):159-163. 10.3988/jcn.2011.7.3.159.

Emergency Microsurgical Embolectomy for the Treatment of Acute Intracranial Artery Occlusion: Report of Two Cases

  • 1Department of Neurosurgery, School of Medicine, Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea. kangsd@wku.ac.kr
  • 2Department of Neurosurgery, Gunsan Medical Center, Gunsan, Korea.


The main treatment for acute arterial ischemic stroke is intravenous or intra-arterial thrombolysis within a particular time window. Endovascular mechanical embolectomy is another treatment option in the case of major artery occlusion. Endovascular mechanical embolectomy is a useful technique for restoring blood flow in patients with large-vessel occlusion, and especially in those who are contraindicated for thrombolytics or in whom thrombolytic therapy has failed.
We report herein two cases of emergency microsurgical embolectomy for the treatment of acute middle cerebral artery and internal carotid artery occlusion as an alternative treatment for major artery occlusion.
Emergency microsurgical mechanical embolectomy may be an alternative treatment option for restoring blood flow in selected patients with large-vessel acute ischemic stroke.


acute ischemic stroke; large-vessel occlusion; microsurgical embolectomy; alternative treatment

MeSH Terms

Carotid Artery, Internal
Middle Cerebral Artery
Thrombolytic Therapy


  • Fig. 1 Case 1. A: Cerebral angiography 5 months prior to the most recent admission showing left cervical internal carotid artery (ICA) stenosis with intraluminal atheroma (arrowhead). B and C: Admission brain CT scans demonstrating a high-density spot at the carotid and Sylvian cistern (arrow) and revealing no abnormalities except for an old localized cerebral infarction in the left temporoparietal lobe along the middle cerebral artery (MCA) territory. D and E: Diffusion and perfusion brain MRI showing diffusion-perfusion mismatch with the finding of acute cerebral infarction and delay of time to peak in the left MCA territory. F: Left ICA angiogram, anteroposterior view, disclosing a left terminal ICA occlusion ("T" occlusion).

  • Fig. 2 Case 1. A and B: Intraoperative photographs showing the occluded terminal ICA. Asterisk indicates the embolus; arrowhead, arteriotomy site. C: Postoperative left ICA angiogram, anteroposterior view, revealing successful ICA recanalization and mild M1 stenosis at the arteriotomy site (arrow). ICA: internal carotid artery.

  • Fig. 3 Case 2. A: Right ICA angiogram, anteroposterior view, showing a right M2 occlusion. B: Right ICA angiogram, after injection of urokinase, revealing recanalization of the M2 branch. C: Follow-up brain CT scan demonstrating an acute subdural hematoma at the left frontotemporoparietal area with a mild mass effect. ICA: internal carotid artery.

  • Fig. 4 Case 2. A: Brain CT angiography (CTA) on the ninth hospital day revealing a right MCA occlusion. B and C: Intraoperative photographs showing the occluded MCA. Asterisk indicates the embolus. D: Postoperative brain diffusion MRI showing a high signal intensity at the right periventricular area (arrow). E: Follow-up CTA showing sufficient blood flow in the right MCA.


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