title: Acute intracranial in-stent thrombosis after angioplasty of middle cerebral artery symptomatic stenosis: a case report.
abstract: BACKGROUND
  Intracranial atherosclerotic disease is one of the major risk factors of ischemic stroke. Percutaneous transluminal angioplasty with stent deployment may be effective for the treatment of symptomatic intracranial stenosis, however its value is yet to be determined. High possibility of serious periprocedural complications, such as acute in-stent thrombosis or stroke, narrows the current recommendations for this treatment to patients with high-grade stenosis (>70%), and to experienced neurointerventional centers.
  
  
  METHODS
  We present a 44-year-old male with symptomatic high-grade stenosis of the M1 segment of left middle cerebral artery, treated with percutaneous transluminal angioplasty with stenting. The procedure was complicated with acute in-stent thrombosis treated with intra-arterial thrombolysis, which resulted in a nondisabling stroke.
  
  
  CONCLUSIONS
  The procedure-related stroke in this patient was probably caused by middle cerebral artery perforator ostium occlusion with balloon predilatation and transient in-stent thrombosis related to insufficient antiplatelet pretreatment. Exhausted cerebrovascular reserve due to long-lasting high-grade intracranial stenosis should also be considered as a factor contributing to ischemic complications.
authors.affiliation: Department of Neurology, Medical University of Silesia, Katowice, Poland. michal.arkuszewski@gmail.com
authors.forename: Michal
authors.initials: M
authors.lastname: Arkuszewski
authors.forename: Magdalena
authors.initials: M
authors.lastname: Targosz-Gajniak
authors.forename: Maciej
authors.initials: M
authors.lastname: Swiat
authors.forename: Jan
authors.initials: J
authors.lastname: Baron
authors.forename: Milosz
authors.initials: M
authors.lastname: Zbroszczyk
authors.forename: Maciej
authors.initials: M
authors.lastname: Jaworski
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Pieta
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Gruszczynska
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opala
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D002533:Cerebral Angiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D007269:Injections, Intra-Arterial; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D015607:Stents; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator