A Case of Ultra Early Embolectomy for ICA Occlusion

This report deales with a case of ultra early embolectomy for an ICA occlusion. A 44-year-old female who suffured sick sinus syndrome had a sudden onset of left hemiparesis. On admission she was drowsy and left hemiparesis was present. An angiogram demonstrated embolic occlusion of the right ICA at the C1-C2 portion.At operation the right MCA was exposed. The embolus appeared to be lodged at the M1M2 bifurcation and also extended into the two main branches. The arteriotomy was made at this bifurcation and the embolus was removed. Four and a half hours after onset, blood flow of the MCA was fully restored. After operation, high-dose barbiturate therapy was administered for four days. A final CT scan showed a low density area in the right M1 perforators' territory, but the patient was discharged with no neurological deficits.Angiographically, the proximal end of the embolus is seen as a deficit of the dye, but the distal end of the embolus is not revealed, while arteriotomy for embolectomy is a suitable procedure for the distal end of the embolus. However, in most ICA occlusion cases, it is suspected that the distal end of the embolus is lodged at the top of the ICA or at the bifurcation of the MCA territory. Therefore, embolectomy would be accomplished by a transsylvian approach if any ICA occlusion exists.