{"title":"Stent Retriever Angioplasty for Intracranial Atherosclerotic Disease-Related Medium Vessel Occlusion: A Case Report and Literature Review.","authors":"Ryoma Inui, Soichiro Abe, Hiroyuki Ishiyama, Takeyoshi Tsutsui, Akimasa Yamamoto, Yuma Shiomi, Takeshi Yoshimoto, Hirotoshi Imamura, Hiroharu Kataoka, Masafumi Ihara","doi":"10.5797/jnet.cr.2024-0053","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Stent retriever (SR) angioplasty is an adjunctive technique for acute large vessel occlusion stroke due to underlying intracranial atherosclerotic disease (ICAD-LVO). Prolonged SR deployment maintains blood flow distal to the atherosclerotic lesion until the antiplatelet agent has exerted its effect. Although SR angioplasty for ICAD-LVO has been reported, few reports are available on SR angioplasty for medium vessel occlusion stroke due to underlying ICAD (ICAD-MeVO). Here, we describe a case of SR angioplasty for acute occlusion of the left M2 segment of the middle cerebral artery (MCA) due to underlying ICAD.</p><p><strong>Case presentation: </strong>A 79-year-old man with a history of left MCA M2 segment stenosis presented with motor aphasia and dysarthria. Diffusion-weighted MRI showed no high-signal intensity areas, and MRA showed occlusion of the left MCA M2 segment. The patient was diagnosed with ICAD-MeVO. After performing an MRI, the patient's symptoms progressed to total aphasia. SR angioplasty was performed for the occlusion of the left M2 segment of the MCA. Diffusion-weighted MRI the day after the procedure showed a small area of high-signal intensity exclusively in the left putamen, while MRA confirmed recanalization of the left MCA M2 segment. Aphasia improved after the procedure. No re-occlusion was observed for 90 days, and the modified Rankin Scale score at 90 days was 2.</p><p><strong>Conclusion: </strong>SR angioplasty appears to be a safe option for managing MCA M2 segment occlusion.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"18 10","pages":"273-277"},"PeriodicalIF":0.0000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491269/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of neuroendovascular therapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5797/jnet.cr.2024-0053","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/14 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
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Abstract
Objective: Stent retriever (SR) angioplasty is an adjunctive technique for acute large vessel occlusion stroke due to underlying intracranial atherosclerotic disease (ICAD-LVO). Prolonged SR deployment maintains blood flow distal to the atherosclerotic lesion until the antiplatelet agent has exerted its effect. Although SR angioplasty for ICAD-LVO has been reported, few reports are available on SR angioplasty for medium vessel occlusion stroke due to underlying ICAD (ICAD-MeVO). Here, we describe a case of SR angioplasty for acute occlusion of the left M2 segment of the middle cerebral artery (MCA) due to underlying ICAD.
Case presentation: A 79-year-old man with a history of left MCA M2 segment stenosis presented with motor aphasia and dysarthria. Diffusion-weighted MRI showed no high-signal intensity areas, and MRA showed occlusion of the left MCA M2 segment. The patient was diagnosed with ICAD-MeVO. After performing an MRI, the patient's symptoms progressed to total aphasia. SR angioplasty was performed for the occlusion of the left M2 segment of the MCA. Diffusion-weighted MRI the day after the procedure showed a small area of high-signal intensity exclusively in the left putamen, while MRA confirmed recanalization of the left MCA M2 segment. Aphasia improved after the procedure. No re-occlusion was observed for 90 days, and the modified Rankin Scale score at 90 days was 2.
Conclusion: SR angioplasty appears to be a safe option for managing MCA M2 segment occlusion.
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