title: Emergent intracranial stenting for acute M2 occlusion of middle cerebral artery.
abstract: OBJECTIVE
  Intracranial stenting is a possible option as a rescue strategy for acute secondary division (M2) occlusion of middle cerebral artery (MCA) when intravenous thrombolysis is ineffective or contraindicated.
  
  
  METHODS
  We reviewed 10 patients of acute M2 occlusion treated by intracranial stenting who were ineligible for intravenous thrombolysis or resistant to intravenous thrombolysis. All patients underwent intracranial stenting with the Wingspan stent system. We analyzed clinical and angiographic outcomes.
  
  
  RESULTS
  The mean NIHSS score on admission was 13.8 points (range 6-23). The occlusion sites were located in the superior division (n=4, left: 3, right: 1), the middle division (n=1, right) and the inferior division (n=5, all: right) of MCA. The mean time interval from stroke symptom onset to stenting was 348.9 ± 90.4 min. Successful recanalization was achieved in all patients. No intracranial hemorrhage, vessel perforations or dissections occurred in any patient. One patient developed acute thrombosis in distal ICA of the stented side at 4 days after a stent placement and was managed with mechanical thrombectomy. All patients improved on the NIHSS (mean amount: 8.8) and to the NIHSS score of 5 ± 4.6 (median 4.5, range 0-15) at 7 days. At discharge, an mRS of ≤ 3 was achieved in 8 patients (80%) and an mRS of ≤ 2 was achieved in 6 patients (60%).
  
  
  CONCLUSIONS
  Endovascular recanalization with a Wingspan stent can be a safe and feasible procedure for acute M2 occlusion when intravenous thrombolysis is ineffective or not available.
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea. Electronic address: aminoff@hanmail.net.
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Sung
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Diagnostic Radiology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Tae Hong
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Han Jin
authors.initials: HJ
authors.lastname: Cho
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Kyu Hyun
authors.initials: KH
authors.lastname: Park
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Dae Soo
authors.initials: DS
authors.lastname: Jung
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D015331:Cohort Studies; D000075202:Contraindications; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Acute ischemic stroke; Intracranial stenting; Recanalization; Second segment of middle cerebral artery; Self-expandable stent