title: Acute M2 bifurcation stenting for cerebral infarction: lessons learned from the heart: technical case report.
abstract: 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.
authors.affiliation: 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.
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.forename: Robert D
authors.initials: RD
authors.lastname: Ecker
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Hanel
authors.forename: Eric
authors.initials: E
authors.lastname: Sauvageau
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Wehman
authors.forename: Lee R
authors.initials: LR
authors.lastname: Guterman
authors.forename: L Nelson
authors.initials: LN
authors.lastname: Hopkins
mesh_terms: 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