Acute M2 bifurcation stenting for cerebral infarction: lessons learned from the heart: technical case report.
OBJECTIVE
Acute ischemic stroke is the third leading cause of death in the United States. For patients with NIHSS scores >10 and evaluated within 6 hours, intra-arterial thrombolysis is the treatment of choice. The Merci retriever (Concentric Medical Inc., Mountain View, CA) and IV TPA are currently the only FDA-approved treatments for acute ischemic stroke. For patients who do not meet the criteria for TPA administration and/or in whom the Merci device fails, options are limited. Intracranial stenting for acute ischemic stroke after failed thrombolysis is now possible because of improved delivery systems and appropriately sized stents.


METHODS
A 26-year-old woman presented with an NIHSS score of 11 (right-sided hemiparesis and mixed aphasia) 4 hours from the time of symptom onset. CT perfusion demonstrated increased time to peak in the entire left hemisphere; conventional angiography demonstrated a left M1 occlusion.


METHODS
After crossing the occlusion with a microcatheter, reteplase (2 units) was administered into the clot. Mechanical thrombolysis was then attempted, without restoration of flow. Two 3 x 12-mm coronary stents were placed from the M1 into the superior and inferior divisions, respectively, with complete restoration of flow (TIMI 3). Within 72 hours, the patient had an NIHSS score of 1, with a small infarction in the external capsule.


CONCLUSIONS
Novel stroke interventions need to be developed for patients with acute ischemic stroke in whom traditional interventions fail. We present (to our knowledge) the first case of successful revascularization of an acute M1 occlusion accomplished with placement of two coronary stents.
Levy
Elad I
EI
Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York 14209, USA.
Ecker
Robert D
RD
Hanel
Ricardo A
RA
Sauvageau
Eric
E
Wehman
J Christopher
JC
Guterman
Lee R
LR
Hopkins
L Nelson
LN
D000328:Adult; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D015607:Stents; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods