Surgical embolectomy for internal carotid artery terminus occlusion

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The aim of this study was to assess the efficacy and safety of surgical embolectomy for internal carotid artery terminus (ICA-T) occlusion. Twenty-five consecutive patients with acute ischemic stroke attributed to embolic ICA-T occlusion who underwent surgical embolectomy were retrospectively reviewed. Twenty-four patients were examined based on magnetic resonance imaging, with one patient included based on a computed tomography scan. Recanalization rate, recanalization time, complications, National Institutes of Health Stroke Scale (NIHSS) score improvement at 1 month, and modified Rankin Scale (mRS) at 3 months were evaluated. Final recanalization status was Thrombolysis in Myocardial Infarction (TIMI) 3 in 24 patients (96 %). Median recanalization time from symptom onset and from start of surgery was 281 and 79 min, respectively. Two patients (8 %) had major hemorrhagic complications related to surgery. Seventeen patients (68 %) demonstrated NIHSS score improvement of more than 10 points at 1 month. At 3 months, eight patients (32 %) were mRS 0–2, five patients (20 %) were mRS 3, and three patients (12 %) had died. Surgical embolectomy for ICA-T occlusion demonstrated a high complete recanalization rate and should be reconsidered as an additional therapeutic strategy to overcome this devastating situation.

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Carotid endarterectomy


Digital subtraction angiography


Diffusion-weighted imaging


Internal carotid artery terminus


Middle cerebral artery


Magnetic resonance angiography


Modified Rankin Scale


National Institutes of Health Stroke Scale


Thrombolysis in Myocardial Infarction


Tissue plasminogen activator


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Conflict of interest

The authors declare that they have no competing interests.

Author information

Correspondence to Tomohiro Inoue.

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Intraoperative video of patient no. 20 (WMV 23,327 kb)

Video 1

Intraoperative video of patient no. 20 (WMV 23,327 kb)

Intraoperative video of patient no. 10 (WMV 1880 kb)

Video 2

Intraoperative video of patient no. 10 (WMV 1880 kb)

Intaroperative video of patient no. 5 (WMV 6841 kb)

Video 3

Intaroperative video of patient no. 5 (WMV 6841 kb)

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Inoue, T., Tamura, A., Tsutsumi, K. et al. Surgical embolectomy for internal carotid artery terminus occlusion. Neurosurg Rev 38, 661–669 (2015).

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  • Carotid terminus
  • Diffusion-weighted imaging
  • Surgical embolectomy
  • Magnetic resonance angiography