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Emergency Carotid Artery Stent Placement in Patients with Acute Ischemic Stroke

Keisuke Imaia, Takahisa Moria, Hajime Izumotoa, Masaki Watanabeb and Kenichiro Majimaa

a Department of Stroke Treatment Shonan Kamakura General Hospital, Kamakura, Japan
b Department of Neurology , Kumamoto University School of Medicine, Kumamoto, Japan



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  		FIG 1. Images obtained on admission in case 1.

A, DW image reveals slightly high signal intensity in the cortex of the left parietal lobe.

B, The rMTT map of PW image shows delay of 15–25% in the territory of the left MCA (ROI 2 and 4).

C, The rCBV map of PW image shows slight decrease of 2–12% in the territory of the left MCA (ROI 2 and 4).

D, The rCBF map of PW image reveals reduction of 11–23% in the territory of the left MCA (ROI 2 and 4).

E, MR angiogram shows poor visualization of the left ICA.



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  		FIG 2. Periprocedural images obtained in case 1.

A, Lateral left carotid angiogram obtained before the procedure shows severe stenosis at the origin of the ICA.

B, Lateral left carotid angiogram obtained during the procedure demonstrates stent implantation and postdilation.

C, Lateral left carotid angiogram obtained after the procedure shows an excellent angiographic result.



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  		FIG 3. Images obtained on admission in case 4.

A, DW image reveals no area of high signal intensity in the left cerebral hemisphere.

B, The rMTT map of PW image shows delay of 15% in the territory of the left MCA (ROI 4).

C, The rCBV map of PW image shows slight decrease of 11.2% in the territory of the left MCA (ROI 4).

D, The rCBF map of PW image reveals reduction of 43% in the territory of the left MCA (ROI 4).

E, MR angiogram shows no visualization of the left ICA.



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  		FIG 4. Periprocedural angiograms obtained in case 4.

A, Lateral left carotid angiogram obtained before the procedure shows occlusion at the origin of the ICA.

B, Lateral left carotid angiogram obtained during the procedure demonstrates stent implantation and postdilation.

C, Lateral left carotid angiogram obtained after the procedure shows essentially complete recanalization with 14% residual stenosis of the ICA.



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  		FIG 5. NIHSS scores at 7 days after emergency carotid stent placement (symbols on right) improved significantly (P < .01) compared with baseline scores (symbols on left). W indicates Wilcoxon rank sum test; •, patients with sudden onset of severe stroke; {blacktriangleup}, patients with progressing stroke.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X