Journal of Neurosurgical Sciences 2022 Feb 11

DOI: 10.23736/S0390-5616.21.05480-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

2-1-2 stroke microsurgical thrombectomy technique as a tertiary/salvage treatment option

Marcelo M. OLIVEIRA ¹ ✉, Leonardo AVELLAR ², Jose A. MALHEIROS ¹, Carlos E. FERRAREZ ¹, Geraldo M. LIMA ¹, Pollyana H. COSTA ¹

¹ Department of Neurosurgery, Federal University of Minas Gerais, Belo Horizonte, Brazil; ² Department of Neurosurgery, Roberto Santos Hospital, Salvador, Brazil

BACKGROUND: Microsurgical thrombectomy (MST) has been used for many years in few stroke cases without any prospective randomized study, nor detailed systemized technique description. As many centers worldwide are recruited for stroke thrombectomy availability, MST might increase in the near future either as a tertiary or salvage treatment option. A straight forward surgical plan is mandatory empowering a safe, efficient and rapid neurosurgical operation, so our aim is to describe the 2-1-2 microsurgical technique.
METHODS: Three patients presented at emergency department with large stroke not suitable to venous thrombolysis and/or mechanical thrombectomy due to late arrival time and endovascular suite technical problems. They were referred to 2-1-2 MST after imaging showed brain collaterals on head angio CT scan and ASPECTS greater than 6 points. The procedure comprised 2 insulin needle puncture in the target artery, 1mm micro-scissor transverse arteriotomy, milk thrombus removal and 2 simple sutures micro stitches. Sixty days clinical follow up and brain imaging control provided data results.
RESULTS: All patients treated with 2-1-2 MST technique had complete thrombus removal by precise surgical maneuvers avoiding surgeons unplanned and insecure movements in order to reduced operation time. Head angio CT scan evidenced complete cerebrovascular circulation re-flow with clinical improvements in 60 days follow up without complications or hospital readmissions.
CONCLUSIONS: 2-1-2 MST technique can be rapidly and efficaciously performed in a systemized manner offering a tertiary or salvage technique for acute stroke treatment. Specific microsurgical training is mandatory to accomplish this treatment and larger studies are necessary to confirm our hypothesis.

KEY WORDS: Microsurgery; Stroke; Thrombectomy; Embolectomy; Microsurgical technique; Cerebrovascular neurosurgery