Open surgical embolectomy for cardiogenic cerebral embolism: Technical note and its advantages

Experience Using Gentian Violet-Free Dyes for Tissue Visualization

BACKGROUND

 Gentian violet ink is used as a skin marker in various surgical procedures, including neurosurgery. The dye is also used to visualize the edges of blood vessels during bypass surgery. However, gentian violet ink carries the risks of carcinogenicity and venous injury, which causes microvascular thrombosis. In this study, we compare the gentian violet-free dye C.I. Basic Violet 4 (BV4) and gentian violet. The usefulness, in terms of color, and formation of microvascular thrombosis in anastomosis were compared.

METHODS

 We used the gentian violet-free dye in 20 cases involving 3 vascular anastomoses. The bone cutting lines on the bone surface, superior temporal artery, and middle cerebral artery were drawn using BV4 and gentian violet ink.

RESULTS

 The colors of BV4 and gentian violet ink were similar. No thrombus formation was observed at the vascular anastomosis when using BV4.

CONCLUSION

 BV4 can be used similarly to gentian violet ink. No adverse effects such as thrombus formation in microvascular anastomosis were experienced when BV4 was used.

Microsurgical thrombectomy: where the ancient art meets the new era

Mechanical thrombectomy (MT) is the leading treatment for acute large vessel occlusion (LVO). However, surgical thrombectomy (ST) may have a role in well selected LVO patients where MT failed to re-establish flow, the endovascular route is inaccessible, or where MT is a financially prohibitive or absent option (developing and poor countries). We compared the efficacy and efficiency between ST and MT, and described our operative experience and its potential application in the developing world. Clinical outcomes, procedural times, and efficacy of treatment were compared between the MT and ST of acute LVO between 2012 and 2022. Propensity score-matched analysis was also conducted to compare MT and ST. One-hundred nine patients fulfilled the study criteria (77 MTs vs 32 STs). Factors driving outcome were age (aOR: 0.95, 95%CI, 0.91-0.98), hemisphere side (aOR: 0.38, 95%CI, 0.15-0.96), and DWI-ASPECT (aOR: 1.39, 95%CI, 1.09-1.77) at presentation by the multivariate analysis. Times from door-start of procedure (P = 0.45) and start of procedure-recanalization (P = 0.13) were similar between treatment options. Propensity score-matched analysis found no significant difference for 2 treatment methods about time of door to recanalization (P = 0.155) and outcome (P = 0.221). The prognosticators of thrombectomy for acute LVO in patients with successful recanalization were age, affected hemisphere side, and DWI-ASPECT score. Our evidence shows that the efficacy of ST is similar to that of MT. There should be a place of ST for cases of mechanical failure or tandem cervical ICA and MCA occlusion. ST may be a temporizing LVO treatment option in healthcare systems where MT is inexistent or financially prohibitive to patients.

The Clinical Noteworthiness of Plasma NT-ProBNP Standard in Sufferers with Cardiogenic Cerebral Embolism and Its Diagnostic Value for Such Sufferers

In order to explore the clinical noteworthiness of plasma NT-proBNP standards in sufferers with cardiogenic cerebral embolism and its diagnostic value for such sufferers, a retrospective study is conducted by the clinical data of sufferers with cerebral embolism. 100 sufferers with cerebral embolism admitted to our hospital from January 2018 to December 2020 are selected. According to the heparin-like drug therapy of acute ischemic stroke test (TOAST) classification criteria, they are divided into cardiac sufferers with cerebral embolism set (43 cases) and noncardiac cerebral embolism set (57 cases). The analysis results show the correlation between serum NT-proBNP standard and neurological impairment score. The detection of-proBNP standard can be used as a diagnostic indicator of disease severity and prognosis for sufferers with cardiogenic cerebral embolism.