Two cases of endovascular treatment using intracranial stent for atherosclerotic middle cerebral artery occlusion

Abstract

  Endovascular treatment for acute large‒vessel occlusion has been widely used, with favorable results. However, in cases with atherothrombotic cerebral infarction, a stent retriever and an aspiration device may not be able to provide reperfusion. Here we report two cases in which an atherothrombotic cerebral infarction was treated successfully using an intracranial stent. Patient 1: A 52‒year‒old man presented with right‒sided paralysis and aphasia. Magnetic resonance angiography (MRA) showed left middle cerebral artery (MCA) occlusion, and urgent endovascular treatment was then performed. While reperfusion was initially obtained using a stent retriever and an aspiration device, re‒occlusion of the MCA subsequently occurred. Due to this recurrence, an intracranial stent was used to treat the occluded MCA. Patient 2: A 78‒year‒old Japanese man presented with transient right‒sided paralysis. MRA showed left MCA stenosis. During hospitalization, the patient developed right‒sided paralysis and aphasia. Repeat MRA showed left MCA occlusion, and endovascular treatment was initiated. Reperfusion could not be achieved using a stent retriever. Subsequently, percutaneous transluminal angioplasty was repeated, but re‒occlusion occurred. Therefore, to successfully achieve reperfusion, an intracranial stent was placed. In both of our patients, the functional prognosis was good. Thus, intracranial stenting can be considered an effective, acute treatment option for an atherothrombotic cerebral infarction.