Transluminal Angioplasty for Middle Cerebral Artery Stenosis in Patients with Acute Ischemic Stroke
Dae Chul Suh
,a,
Kyu-Bo Sunga,
Yong Soo Choa,
Choong Gon Choia,
Ho Kyu Leea,
Jae Hong Leea,
Jong Sung Kima and
Myoung Chong Leea
a From the Departments of Radiology (D.C.S., K-B.S., Y.S.C., C.G.C., H.K.L.) and Neurology (J.H.L., J.S.K., M.J.L.), Asan Medical Center University of Ulsan, College of Medicine, Seoul, Korea.
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FIG 1. Patient 1: 31-year-old man with multiple TIAs.
A, T2-weighted MR image (4000/200/4 [TR/TE/excitations]) shows high signal intensity in the deep portion of the right MCA territory.
B, Right internal carotid arteriogram shows a high-grade stenosis at the M1 segment. The watershed zone is shifted toward the MCA side (asterisk).
C, Saved roadmap fluoroscopic image shows an inflated balloon at the stenotic site.
D, Angiogram obtained after angioplasty shows relived stenosis and shift of the watershed zone toward the ACA side (asterisk).
E, Follow-up angiogram obtained 8 months later shows a remodeling of the M1 segment without recurrence of stenosis.
F, SPECT scan before angioplasty shows decreased perfusion in the right cerebral hemisphere.
G, SPECT scan 5 days after angioplasty shows increased perfusion.
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FIG 2. Patient 7: 45-year-old woman with stroke.
A, Right internal carotid arteriogram shows tight stenosis with ulceration in the M1 segment.
B, Saved roadmap fluoroscopic image shows a dilated balloon at the stenotic site.
C, Angiogram obtained after angioplasty shows a focal spasm at the distal end of the balloon position (arrow).
D, Final angiogram obtained after nitroglycerin infusion shows no further spasm and improved flow into the MCA.
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