Successful stenting seven days after atherothrombotic occlusion of the intracranial internal carotid artery.
OBJECTIVE
To report a case of successful stenting after a subacute stroke.


METHODS
A 75-year-old man presented with sudden onset of right-sided weakness and difficulty speaking. Imaging revealed an occlusion of the left petrous to lacerum internal carotid artery (ICA) segment and slightly decreased cerebral blood flow in the left hemisphere; there were stenoses of the ostial and cavernous ICA segments on the right. On the seventh day after the stroke, he underwent protected carotid angioplasty of the left intracranial ICA occlusion to reduce the high risk of ischemic stroke owing to bilateral disease. An external arteriovenous shunt was established with an occluding balloon in the proximal ICA and a filter in the femoral vein. After protected balloon dilation of the ICA occlusion, a 3.5 x 18-mm balloon-expandable coronary stent was deployed across the residual stenotic segment. An intraluminal filling defect of the petrous ICA segment suggested an arterial dissection or intraluminal thrombus, so another 2 coronary stents were deployed. Macroscopically visible materials were captured in the filter. The patient had a good clinical course and was discharged without neurological deficits on the twelfth day after the stroke. Angiography at 3 months confirmed no restenosis of the stented vessel.


CONCLUSIONS
This experience suggests that short atherothrombotic intracranial ICA occlusions can be opened in the subacute stroke stage without distal migration of thrombi under proximal protection and flow reversal.
Imai
Keisuke
K
Department of Stroke Treatment, Shonan Kamakura General Hospital, Kanagawa, Japan.
Mori
Takahisa
T
Izumoto
Hajime
H
Takabatake
Nozomu
N
Kunieda
Takenobu
T
Yamamoto
Shinji
S
Watanabe
Masaki
M
D000368:Aged; D000800:Angioplasty, Balloon; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D015607:Stents; D020521:Stroke / Q000209:etiology* / Q000601:surgery*