Empty microcatheter technique for the deployment of a self-expanding stent to treat refractory middle cerebral artery occlusion in the setting of severe proximal tortuosity.
We report a case of an acute middle cerebral artery (M2 segment) occlusion that was refractory to intravenous tissue plasminogen activator (IV t-PA), thrombectomy with the Merci device, intra-arterial infusion of urokinase and eptifibatide, and balloon angioplasty. The artery was so tortuous that over-the-wire stent placement failed and a salvage technique was required to place the self-expanding stent.
Dabus
Guilherme
G
Department of Interventional Neuroradiology and Endovascular Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Nogueira
Raul G
RG
D000368:Aged; D000800:Angioplasty, Balloon; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D002404:Catheterization / Q000379:methods*; D000077542:Eptifibatide; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D007261:Infusions, Intra-Arterial; D007275:Injections, Intravenous; D008904:Miniaturization; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D010455:Peptides / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D015607:Stents; D017131:Thrombectomy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator; D000077542:Eptifibatide