Hybrid operating room for the treatment of complex neurovascular and brachiocephalic lesions

Koji Iihara, Tetsu Satow, Toshinori Matsushige, Hiroharu Kataoka, Norio Nakajima, Kenji Fukuda, Makoto Isozaki, Daisuke Maruyama, Takuro Nakae, Nobuo Hashimoto

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Abstract

Background: We examine the impact of the installation of integrated hybrid operating rooms (ORs) that allow both surgical and endovascular procedures and are designed for less invasive and 1-stage treatment of complex neurovascular lesions. Methods: We retrospectively analyzed our experience in the treatment of complex neurovascular lesions in a hybrid OR. Results: Three patients with distal middle cerebral artery (MCA) aneurysms underwent a proximal clip occlusion or endovascular trapping with a superficial temporal artery-MCA bypass after correct localization of the recipient branch distal to the aneurysm using superselective intra-arterial infusion of indocyanine green under an operating microscope. Two patients with innominate artery stenosis were treated with retrograde stenting from the common carotid artery (CCA) with distal protection of the internal carotid artery (ICA) alone, and with antegrade stenting with dual protection of the ipsilateral ICA and the vertebral artery. Two patients with tandem stenosis of the proximal CCA and carotid bifurcation underwent 1-stage retrograde stenting combined with a carotid endarterectomy. A patient with the innominate artery and the proximal CCA stenosis underwent staged percutaneous antegrade angioplasty of the innominate artery followed by retrograde stenting of both lesions. A patient with tandem stenosis of the subclavian and innominate arteries underwent 1-stage retrograde stenting. In 2 patients with carotid stenosis that was difficult to access via the endovascular route, carotid stenting was performed by direct puncture of the proximal CCA. No patients suffered from new postoperative neurologic deficits. Conclusions: The integration of a high-end hybrid OR enables combined endovascular and surgical procedures for complex neurovascular and brachiocephalic lesions in a 1-stage treatment.

Original languageEnglish
Pages (from-to)e277-e285
JournalJournal of Stroke and Cerebrovascular Diseases
Volume22
Issue number8
DOIs
Publication statusPublished - Nov 2013

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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    Iihara, K., Satow, T., Matsushige, T., Kataoka, H., Nakajima, N., Fukuda, K., Isozaki, M., Maruyama, D., Nakae, T., & Hashimoto, N. (2013). Hybrid operating room for the treatment of complex neurovascular and brachiocephalic lesions. Journal of Stroke and Cerebrovascular Diseases, 22(8), e277-e285. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.07.014