title: Three cases of middle cerebral artery occlusion emergently revascularized with a balloon-expandable coronary bare stent after intravenous tissue plasminogen activator.
abstract: BACKGROUND
  Revascularization with emergency stent placement in patients with acute middle cerebral artery occlusion is still controversial in Japan.
  
  
  METHODS
  We placed balloon-expandable coronary bare stents in 3 patients in whom revascularization was not obtained after intravenous tissue plasminogen activator therapy (IV t-PA) for acute ischemic stroke (middle cerebral artery M1 occlusion).
  
  
  RESULTS
  Patient 1 was an 87-year-old woman with left hemiplegia. Her National Institutes of Health Stroke Scale score (NIHSS) was 12, and her magnetic resonance imaging diffusion-weighted image Alberta Stroke Programme Early Computed Tomography Score (MRI DWI-ASPECTS) was 8. Adequate revascularization was not obtained with IV t-PA and adjunctive percutaneous transluminal angioplasty (PTA) for right M1 occlusion, and a stent was placed 368 minutes after onset. Her Thrombolysis in Myocardial Infarction Trial (TIMI) score was 2. After 90 days, her modified Rankin scale (mRS) score was 4. Patient 2 was a 65-year-old woman with left hemiplegia. Her NIHSS score was 16, and MRI DWI-ASPECTS was 9. A stent was placed 337 minutes after onset after IV t-PA and adjunctive PTA for right M1 occlusion. Her TIMI score was 3. After 90 days, her mRS score was 3. Patient 3 was a 61-year-old woman with left hemiplegia. Her NIHSS score was 18, and MRI DWI-ASPECTS score was 7. Arterial dissection was found after IV t-PA and adjunctive PTA for the right M1 occlusion, so a stent was placed 312 minutes after onset. Her TIMI score was 2. After 90 days, her mRS score was 0.
  
  
  CONCLUSIONS
  Revascularization with emergency stent placement seems likely to be successful in patients with acute middle cerebral artery occlusion, but clinical symptoms do not always improve in some cases and care is needed in selecting patients for the procedure.
authors.affiliation: Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan. tfukuoka@saitama-med.ac.jp
authors.forename: Takuya
authors.initials: T
authors.lastname: Fukuoka
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Dembo
authors.forename: Harumitu
authors.initials: H
authors.lastname: Nagoya
authors.forename: Ichiro
authors.initials: I
authors.lastname: Deguchi
authors.forename: Hajime
authors.initials: H
authors.lastname: Maruyama
authors.forename: Ryuzaburo
authors.initials: R
authors.lastname: Kanazawa
authors.forename: Shinya
authors.initials: S
authors.lastname: Kohyama
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Yamane
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Ishihara
authors.forename: Norio
authors.initials: N
authors.lastname: Tanahashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D002533:Cerebral Angiography / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging; D004185:Disability Evaluation; D004630:Emergencies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D015607:Stents; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator