- 作者：Takuya Fukuoka ; MD&lowast ; ; tfukuoka@saitama-med.ac.jp ; Tomohisa Dembo ; MD&lowast ; ; Harumitu Nagoya ; MD&lowast ; ; Ichiro Deguchi ; MD&lowast ; ; Hajime Maruyama ; MD&lowast ; ; Ryuzaburo Kanazawa ; MD&dagger ; ; Shinya Kohyama ; MD&dagger ; ; Fumitaka Yamane ; MD&dagger ; ; Shoichiro Ishihara ; MD&dagger ; ; Norio Tanahashi ; MD&lowast ;
- 关键词：Acute ischemic stroke ; adjunctive percutaneous transluminal angioplasty ; balloon-expandable stent ; tissue plasminogen activator
- 刊名：Journal of Stroke and Cerebrovascular Diseases
- 出版年：2012
- 出版时间：November, 2012
- 年：2012
- 卷：21
- 期：8
- 页码：883-889
- 全文大小：693 K
Background
Revascularization with emergency stent placement in patients with acute middle cerebral artery occlusion is still controversial in Japan.Methods
We placed balloon-expandable coronary bare stents in 3 patients in whom revascularization was not obtained after intravenous tissue plasminogen activator therapy (IV t-PA) for acute ischemic stroke (middle cerebral artery?M1 occlusion).
Results
Patient 1 was an 87-year-old woman with left hemiplegia.?Her National Institutes of Health Stroke Scale score (NIHSS) was 12, and her magnetic resonance imaging diffusion-weighted image Alberta Stroke Programme?Early Computed Tomography Score (MRI DWI-ASPECTS) was 8. Adequate revascularization was not obtained with IV t-PA and adjunctive percutaneous transluminal angioplasty (PTA) for right M1 occlusion, and a stent was placed 368 minutes after onset. Her Thrombolysis in Myocardial Infarction Trial (TIMI) score was 2. After 90 days, her modified Rankin scale (mRS) score was 4. Patient 2 was a 65-year-old woman with left hemiplegia. Her NIHSS score was 16, and MRI DWI-ASPECTS was 9. A stent was placed 337 minutes after onset after IV t-PA and adjunctive PTA for right M1 occlusion. Her TIMI score was 3. After 90 days, her mRS score was 3. Patient 3 was a 61-year-old woman with left hemiplegia. Her NIHSS score was 18, and MRI DWI-ASPECTS score was 7. Arterial dissection was found after IV t-PA and adjunctive PTA for the right M1 occlusion, so a stent was placed 312 minutes after onset. Her TIMI score was 2. After 90 days, her mRS score was 0.
Conclusions
Revascularization with emergency stent placement seems likely to be successful in patients with acute middle cerebral artery occlusion, but clinical symptoms do not always improve in some cases and care is needed in selecting patients for the procedure.