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Self-expanding stent-assisted middle cerebral artery recanalization: technical note

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

Investigation into pharmacological and mechanical means of improving recanalization rates by intraarterial therapy has led to technological development. Angiographic recanalization has been associated with improvement in clinical outcome. A clot retriever has recently joined an imperfect armamentarium for intraarterial stroke therapy. In this report, we describe successful recanalization of an acute thrombotic occlusion of the inferior division of the middle cerebral artery (MCA) achieved with a self-expanding stent.

Methods

An 82-year-old woman with a history of coronary atherosclerosis and previous cerebellar hemorrhage presented with a National Institutes of Health Stroke Scale (NIHSS) score of 11. Perfusion computed tomography imaging showed a left MCA territory deficit. Diffusion-weighted magnetic resonance (MR) imaging revealed a small punctiform insular hyperintensity. Angiography documented occlusion of the inferior division of the left MCA (Thrombolysis in Myocardial Infarction or Thrombolysis in Cerebral Infarction, TIMI/TICI, grade 0). Intraarterial delivery of eptifibatide to the occlusion site failed to recanalize the vessel. Deployment of a self-expanding stent in the occluded segment resulted in complete revascularization of the distal vascular bed.

Results

Angiography performed on the next day confirmed patency of the stented vessel segment (TIMI/TICI 3). The patient was discharged 3 days after the procedure (NIHSS 3). MR angiography obtained 3 months after the procedure documented left MCA patency.

Conclusion

This technique may have a role worthy of further investigation in acute stroke therapy.

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Acknowledgement

We thank Paul H. Dressel for preparation of the illustrations.

Conflict of interest statement Dr. Levy is in receipt of industry grant support: Boston Scientific Corporation (co-principal investigator) and honoraria (symposia): Boston Scientific Corporation. Dr. Sauvageau has nothing to disclose.

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Authors and Affiliations

  1. Department of Neurosurgery,School of Medicine and Biomedical Sciences, University at Buffalo,State University of New York, Buffalo, NY, USA

    Eric Sauvageau & Elad I. Levy

  2. Department of Radiology,School of Medicine and Biomedical Sciences, University at Buffalo,State University of New York, Buffalo, NY, USA

    Elad I. Levy

  3. Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo,State University of New York, Buffalo, NY, USA

    Eric Sauvageau & Elad I. Levy

Authors
  1. Eric Sauvageau
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  2. Elad I. Levy
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Correspondence to Elad I. Levy.

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Sauvageau, E., Levy, E.I. Self-expanding stent-assisted middle cerebral artery recanalization: technical note. Neuroradiology 48, 405–408 (2006). https://doi.org/10.1007/s00234-006-0077-0

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  • DOI: https://doi.org/10.1007/s00234-006-0077-0

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