Home >> Neurological Research, Volume 28, Number 8

Endovascular thrombolysis and stenting of a middle cerebral artery occlusion beyond 6 hours post-attack: special reference to the usefulness of diffusion–perfusion MRI

Authors: Ahn, Jung Yong1; Han, In Bo1; Chung, Sang Sup1; Chung, Young Sun1; Kim, Sang Heum2; Yoon, Pyeong Ho2

Source: Neurological Research, Volume 28, Number 8, December 2006 , pp. 881-885(5)

Publisher: Maney Publishing

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Abstract:

Intra-arterial thrombolysis and percutaneous angioplasty is feasible in patients with acute middle cerebral artery (MCA) occlusion limited to 6 hours post-ictus, but there are some limitations such as reocclusion or hemorrhagic complications. In this report, we describe a stent placement in the treatment of a refractory artherothrombotic MCA occlusion beyond 6 hours of symptom onset. A 57-year-old man presented with a progressive left-sided weakness and verbal disturbance resulting from an acute thrombotic occlusion of the right MCA superimposed on severe proximal atheromatous stenosis. Diffusion?perfusion magnetic resonance imaging (MRI) demonstrated the significant diffusion?perfusion mismatch. After chemical and mechanical thrombolysis of the clot, balloon angioplasty of the underlying MCA stenosis was performed 2 days post-attack, without significant angiographic improvement. Percutaneous endovascular deployment of a stent (Driver 2.5 ? 12 mm, MTI, Irvine, CA) was subsequently performed, with excellent angiographic results. Follow-up diffusion?perfusion MRI showed improved perfusion in the hypoperfused area. The patient's National Institutes of Health Stroke Scale (NIHSS) score was increased from 12 to 3. Clot thrombolysis and subsequent stenting in patients with refractory proximal MCA occlusion is feasible and allows for a significant reduction in the amount of thrombolytic drug required. In selective patients with acute MCA occlusion, the therapeutic window for recanalization procedures can be safely and effectively extended beyond the 'traditional 6 hours'. Diffusion?perfusion MRI in acute MCA occlusion is important for indication of therapy.

Keywords: DIFFUSION; PERFUSION; MIDDLE CEREBRAL ARTERY; STROKE; MAGNETIC RESONANCE IMAGING; STENT PLACEMENT

Document Type: Research Article

DOI: http://dx.doi.org/10.1179/016164105X49355

Affiliations: 1: Department of Neurosurgery, Pundang CHA Hospital, 351, Yatap-dong, Pundang-gu, Sungnam 463712, Korea 2: Department of Radiology, Pundang CHA Hospital, 351, Yatap-dong, Pundang-gu, Sungnam 463712, Korea

Publication date: 2006-12-01

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