Article Figures & Data
Figures
- Fig 1.
A 63-year-old man (patient 9) presented with acute infarction in the right MCA territory. A, DWI shows acute infarction in the right basal ganglia and frontal lobe (NIHSS score is 20 points). B, CT perfusion images show perfusion defect with large area of diffusion/perfusion mismatching in the right MCA territory. C, Right ICA angiogram shows complete occlusion of proximal M1 segment. On ICA angiogram after a Wingspan stent deployment, anteroposterior view (D) shows moderate to severe stenosis (arrows) within stent, and lateral view (E) reveals thrombosis (arrow) at inferior M2 segment distal to the stent and no recanalization of the superior M2 segment. F, Balloon angioplasty (arrow) is performed for the stenosis. The thrombosis distal to stent is solved by intra-arterial urokinase injection (not shown). G, Immediate postprocedural angiogram reveals complete recanalization of the M1 and inferior M2 segments (TICI grade 2a with sufficient collateral flow). H, MRA performed at 9 days postprocedure shows additional recanalization of the right superior M2 segment (arrow) without reocclusion (NIHSS score is 0 at 7 days postprocedure).
- Fig 2.
A 67-year-old man (patient 5) presented with acute infarction in the right MCA territory. A, DWI shows acute infarction in the right basal ganglia and frontal and parietal lobes (NIHSS score is 9 points). B, Lateral view of the right ICA angiogram shows complete occlusion of M1 segment. C, Poststenting angiogram after Wingspan stent deployment (arrows) reveals complete recanalization of MCA. D, Immediate postprocedural angiogram reveals complete recanalization without luminal thrombosis (TICI grade 3) of the MCA. E, Multiple lesions of contrast enhancement (arrows) are noted at infarcted area on immediate postprocedural nonenhanced CT. F, 2-day postprocedure CT shows no intracranial hemorrhage (NIHSS score is 3 points at days postprocedure).
- Fig 3.
A 40-year-old woman (patient 3) presented with acute infarction in the right MCA territory. A, DWI shows acute infarction in the right MCA territory (NIHSS score is 18 points). B, Lateral view of the right ICA angiogram shows complete occlusion of the inferior M2 segment (arrow). C and D, Lateral radiograph and angiogram after Wingspan stent deployment reveal partial recanalization with residual thrombosis of inferior M2 segment. E, Urokinase is administered for remnant thrombus in cortical arteries after Wingspan deployment. F, Final angiogram reveals near-complete recanalization (TICI grade 2b with sufficient collateral flow) of the MCA (NIHSS is improved up to 5 points at 7 days postprocedure).
Tables
- Table 1.
Patient characteristics and clinical outcomes of thrombolysis using stenting for acute MCA occlusion
Patient Sex Age Time (minutes) NIHSS Score mRS at Discharge Sx Onset to Arrival Arrival to Stenting Sx Onset to Stenting Initial 7 Days (Change) 1 M 40 141 161 302 9 5 (4↓) 2 2 M 71 94 196 290 24 13 (8↓) 3 3 F 40 204 91 295 18 5 (13↓) 3 4 M 56 44 273 317 12 9 (3↓) 3 5 M 67 114 286 400 9 3 (6↓) 1 6 F 76 28 178 206 19 0 (19↓) 1 7 M 80 47 404 451 9 9 (→) 2 8 M 55 207 175 382 4 0 (4↓) 0 9 M 63 300 66 366 20 0 (20↓) 0 10 F 78 139 300 439 6 0 (6↓) 0 -
Note:—Sx indicates symptom.
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- Table 2.
Lesions characteristics, stents used, complications, and angiographic results of thrombolysis using stenting for acute MCA occlusion
Patient Occlusion Segment of MCA IV tPA Stent Used (mm) PTA for Stenosis IA UK (Unit) IA ReoPro Procedural Complications Symptomatic ICH TICI Grade 1 M1 Done 3.0/20 Done 300 000 None None 3 2 M1 Done 3.0/20 Done 200 000 None None 3 3 M2 Done 2.5/20 No 300 000 None None 2b 4 M1 Done 3.0/20 Done None None 2b 5 M1 No 3.0/15 No None None 3 6 M2 Done 2.5/20 No 500 000 10 mg None None 2b 7 M1 Done 3.0/9 & 3.5/9 Done None None 3 9 M1 No 3.0/20 No 220 000 None None 3 9 M1 No 3.0/20 Done 100 000 None None 2a 10 M2 No 3.5/20 & 3.5/20 Done 10 mg None None 3 -
Note:—IA indicates intra-arterial; ICH, intracranial hemorrhage; PTA, percutaneous balloon angioplasty; UK, urokinase.
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