Acute M2 bifurcation stenting for cerebral infarction: lessons learned from the heart: technical case report

Neurosurgery
Elad I LevyL Nelson Hopkins

Abstract

Acute ischemic stroke is the third leading cause of death in the United States. For patients with NIHSS scores >10 and evaluated within 6 hours, intra-arterial thrombolysis is the treatment of choice. The Merci retriever (Concentric Medical Inc., Mountain View, CA) and IV TPA are currently the only FDA-approved treatments for acute ischemic stroke. For patients who do not meet the criteria for TPA administration and/or in whom the Merci device fails, options are limited. Intracranial stenting for acute ischemic stroke after failed thrombolysis is now possible because of improved delivery systems and appropriately sized stents. A 26-year-old woman presented with an NIHSS score of 11 (right-sided hemiparesis and mixed aphasia) 4 hours from the time of symptom onset. CT perfusion demonstrated increased time to peak in the entire left hemisphere; conventional angiography demonstrated a left M1 occlusion. After crossing the occlusion with a microcatheter, reteplase (2 units) was administered into the clot. Mechanical thrombolysis was then attempted, without restoration of flow. Two 3 x 12-mm coronary stents were placed from the M1 into the superior and inferior divisions, respectively, with complete restoration of flow (TIMI 3). Wit...Continue Reading

References

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Citations

Apr 20, 2006·Neuroradiology·Eric Sauvageau, Elad I Levy
Sep 21, 2010·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Ramy A BadawiJohn P Reilly
Mar 19, 2014·Clinical Neurology and Neurosurgery·Sang Min SungDae Soo Jung
Mar 11, 2006·Neurosurgery·Elad I LevyL Nelson Hopkins
Oct 21, 2006·Neurosurgery·Erol Veznedaroglu, Elad I Levy
Oct 16, 2010·Stroke; a Journal of Cerebral Circulation·C RothW Reith

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