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New devices and techniques
Original research
Emergent microsurgical intervention for acute stroke after mechanical thrombectomy failure: a prospective study
  1. Jiří Fiedler1,2,
  2. Martin Roubec3,4,
  3. Marek Grubhoffer1,2,
  4. Svatopluk Ostrý5,6,
  5. Václav Procházka7,
  6. Kateřina Langová8,
  7. David Školoudík4,7
  8. for the EMIAS Study Group
    1. 1Department of Neurosurgery, Nemocnice České Budějovice, České Budějovice, Jihočeský, Czech Republic
    2. 2Department of Neurosurgery, Univerzita Karlova Lékařská fakulta v Plzni, Plzeň, Plzeňský, Czech Republic
    3. 3Department of Neurology, University Hospital Ostrava, Ostrava, Moravskoslezský, Czech Republic
    4. 4Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Moravskoslezský, Czech Republic
    5. 5Department of Neurology, Nemocnice České Budějovice, České Budějovice, Jihočeský, Czech Republic
    6. 6Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Praha, Praha, Czech Republic
    7. 7Department of Radiology, University Hospital Ostrava, Ostrava, Moravskoslezský, Czech Republic
    8. 8Department of Biophysics, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Olomoucký, Czech Republic
    1. Correspondence to Professor David Školoudík, Center for Health Research, University of Ostrava Faculty of Medicine, Ostrava, Czech Republic; skoloudik{at}hotmail.com

    Abstract

    Background Despite all the gains that have been achieved with endovascular mechanical thrombectomy revascularization and intravenous thrombolysis logistics since 2015, there is still a subgroup of patients with salvageable brain tissue for whom persistent emergent large vessel occlusion portends a catastrophic outcome.

    Objective To test the safety and efficacy of emergent microsurgical intervention in patients with acute ischemic stroke and symptomatic middle cerebral artery occlusion after failure of mechanical thrombectomy.

    Methods A prospective two-center cohort study was conducted. Patients with acute ischemic stroke and middle cerebral artery occlusion for whom recanalization failed at center 1 were randomly allocated to the microsurgical intervention group (MSIG) or control group 1 (CG1). All similar patients at center 2 were included in the control group 2 (CG2) with no surgical intervention. Microsurgical embolectomy and/or extracranial–intracranial bypass was performed in all MSIG patients at center 1.

    Results A total of 47 patients were enrolled in the study: 22 at center 1 (12 allocated to the MSIG and 10 to the CG1) and 25 patients at center 2 (CG2). MSIG group patients showed a better clinical outcome on day 90 after the stroke, where a modified Rankin Scale score of 0–2 was reached in 7 (58.3%) of 12 patients compared with 1/10 (10.0%) patients in the CG1 and 3/12 (12.0%) in the CG2.

    Conclusions This study demonstrated the potential for existing microsurgical techniques to provide good outcomes in 58% of microsurgically treated patients as a third-tier option.

    • Stroke
    • Thrombectomy
    • Thrombolysis

    Data availability statement

    Data are available in a public, open access repository. Dataset is available: Školoudík, David (2021), “EMIAS Study”, Mendeley Data, V1, doi: 10.17632/ptmn436pzm.1.

    https://doi.org/10.1136/neurintsurg-2022-018643

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      Data availability statement

      Data are available in a public, open access repository. Dataset is available: Školoudík, David (2021), “EMIAS Study”, Mendeley Data, V1, doi: 10.17632/ptmn436pzm.1.

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      Footnotes

      • JříF and MR contributed equally.

      • Correction notice This paper has been corrected since it was published online. Originally, only figure 1 with the caption for figure 2 was uploaded and published. We have now uploaded both figures 1 and 2 with their captions.

      • Collaborators EMIAS Study Group: Miroslava Nevšímalová, Martin Reiser (Department of Neurology, České Budějovice Hospital, České Budějovice, Czech Republic), Jindřich Sova, Karel Hes, Petr Mašek (Department of Radiology, České Budějovice Hospital, České Budějovice, Czech Republic), Martin Bombic (Department of Neurosurgery, České Budějovice Hospital, České Budějovice, Czech Republic), Eva Hurtíková (Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic) Jan Krajča, Tomáš Jonszta, Daniel Czerný (Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic)

      • Contributors JF made a substantial contribution to the concept and design, analysis and interpretation of data; drafted the article; approved the version to be published. He is a guarantor. MR made a substantial contribution to the concept and design, analysis and interpretation of data; drafted the article; approved the version to be published. MG, SO, and VP revised the article critically for important intellectual content; approved the version to be published. KL made a substantial contribution to the study design, analysis and interpretation of data; revised the article critically for important intellectual content; approved the version to be published. DŠ made a substantial contribution to the concept and design, acquisition of data; approved the version to be published.

      • Funding This work was supported by the Ministry of Health of the Czech Republic grants number NV-19-04-00270, NU22-04-00389, and Palacký University grant number JG_2019_004.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.