Background: In a short window of time, intravenous and intra-arterial thrombolysis is the first treatment option for patients with an acute ischemic stroke caused by the occlusion of one of the major brain vessels. Endovascular treatment techniques provide additional treatment options. In selected cases, high revascularization rates following microsurgical thrombembolectomy in the anterior circulation were reported. A technical note on successful thrombembolectomy of the proximal PCA has not yet been published.
Objective: To describe the technique of microsurgical thrombembolectomy of an acute proximal posterior cerebral artery occlusion and their brainstem perforators via the anterior temporal approach.
Methods: The authors present a technical report of a successful thrombembolectomy in the proximal posterior cerebral artery. The 64-year-old male patient had an acute partial P1 thrombembolic occlusion, with contraindications for intravenous r-tPA. The patient underwent an urgent microsurgical thrombembolectomy after a frontotemporal craniotomy.
Results: The postoperative CTA showed complete recanalization of the P1 segment and their perforators, which were previously occluded. The early outcome after one month and one year follow-ups showed improvement from mRS 4 to mRS 1.
Conclusion: Microsurgical thrombembolectomy can be an effective treatment option for proximal occlusion of the posterior cerebral artery in selected cases and experienced hands. Compared to endovascular treatment, direct visual control of brainstem perforators is possible.
From: The Anterior Temporal Approach for Microsurgical Thrombembolectomy of an Acute Proximal Posterior Cerebral Artery Occlusion by Goehre et al.