World Neurosurg
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A patient presented with progressive ischemic stroke and received mechanical thrombectomy with a Solitaire FR device 29 days after stroke onset. The occluded V4 segment of the left vertebral artery showed a double rail sign on angiography, which indicated that the occlusion might have been caused by embolism instead of stenosis. The mechanical thrombectomy procedure was a 1-pass success and the patient was functionally independent with a modified Rankin Scale score of 1 at 3-month follow-up. The appearance of the vascular wall (double rail sign) of the occluded cerebral vascular segment on angiography may be a significant feature to identify the character of the occlusion even a long time after onset, which is important when planning further endovascular therapy in patients with ischemic stroke.
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Microsurgery is technically demanding, treacherous, venturesome, and precarious. For the best outcomes, the surgeon's confidence, prudence, comfort, and relaxed body posture are crucial for controlling operator fatigue and preventing exhaustion. Often, the most critical and demanding parts of an operation occur hours into the case when fatigue has worn away the surgeon's patience and self-control-qualities required to pursue calculated and deliberate microsurgical movements. The following paper describes philosophies and strategies to advance an operator's efficiency and minimize fatigue.