Preliminary Results of Endovascular Stent-Assisted Angioplasty for Symptomatic Middle Cerebral Artery Stenosis
Tae Hong Leea,
Dong Hyun Kimd,
Byung-Hee Leee,
Hak Jin Kima,
Chang Hwa Choib,
Kyung Pil Parkc,
Dae Soo Jungc,
Suk Kima and
Tae Yong Moona
a Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine
b Department of Neurosurgery, Pusan National University Hospital, Pusan National University School of Medicine
c Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine
d Department of Diagnostic Radiology, Chosun University Hospital, Chosun University School of Medicine, Kwangju
e Department of Diagnostic Radiology, Anyang Metrohospital, Republic of Korea
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FIG 1. A 71-year-old woman with recurrent TIA symptoms.
A, Anteroposterior oblique left ICA angiogram shows severe stenosis (about 70%, arrow) in the M1 portion of the left MCA.
B, Balloon-mounted coronary stent (arrow) is positioned at the lesion, and the microwire is anchored in the distal branch of the MCA.
C, At 4 atm, the balloon is initially expanded at the distal and proximal ends of the stent (dumbbell phenomenon, arrows).
D, At 6 atm, the balloon expands in the center section containing the stent (arrow).
E, When no gap is present between the distal end of the stent and the parent artery on angiography, the balloon tip (long arrow) is pulled back into the distal end of the stent (short arrow) to prevent dissection and rupture of the parent artery. Balloon inflation is restarted.
F, Immediate postprocedural anteroposterior left ICA angiogram shows excellent recanalization (arrow) of the diseased segment, with preservation of the lateral lenticulostriate arteries.
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FIG 2. A 67-year-old man with recurrent TIA symptoms.
A, Anteroposterior left ICA angiogram shows severe stenosis (about 90%, arrow) in the proximal M1 portion of the left MCA.
B, Balloon-mounted coronary stent (arrow) is successfully deployed.
C, Postprocedural ICA angiogram shows acute in-stent thrombosis (arrow).
D, Final ICA angiogram after thrombolysis with abciximab shows the MCA (arrow) with a smooth appearance, normalized luminal diameter, and preservation of the lenticulostriate arteries.
E, Angiogram at 10 months after the procedure shows asymptomatic, mild (20%) in-stent restenosis (arrow) due to intimal hyperplasia.
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FIG 3. A 58-year-old woman with recurrent TIA and infarction symptoms involving the left MCA territories.
A, Anteroposterior left ICA angiogram shows diffuse severe stenosis (about 90%, arrow) in the total M1 portion of the right MCA.
B, Anteroposterior radiograph shows the stent (arrow) during deployment in the M1 portion.
C and D, After stent deployment, left ICA angiogram shows extravasation of contrast agent in the stent (arrow) due to a vascular tear.
E, Second stent (arrow) is inserted over the tear site.
F, Postprocedural anteroposterior left ICA angiogram shows the near-normal diameter of the vessel, with no extravasation of contrast agent (arrow).
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