Article Figures & Data
Figures
- Fig 1.
A 71-year-old woman with recurrent TIA symptoms.
A, Anteroposterior oblique left ICA angiogram shows severe stenosis (about 70%, arrow) in the M1 portion of the left MCA.
B, Balloon-mounted coronary stent (arrow) is positioned at the lesion, and the microwire is anchored in the distal branch of the MCA.
C, At 4 atm, the balloon is initially expanded at the distal and proximal ends of the stent (dumbbell phenomenon, arrows).
D, At 6 atm, the balloon expands in the center section containing the stent (arrow).
E, When no gap is present between the distal end of the stent and the parent artery on angiography, the balloon tip (long arrow) is pulled back into the distal end of the stent (short arrow) to prevent dissection and rupture of the parent artery. Balloon inflation is restarted.
F, Immediate postprocedural anteroposterior left ICA angiogram shows excellent recanalization (arrow) of the diseased segment, with preservation of the lateral lenticulostriate arteries.
- Fig 2.
A 67-year-old man with recurrent TIA symptoms.
A, Anteroposterior left ICA angiogram shows severe stenosis (about 90%, arrow) in the proximal M1 portion of the left MCA.
B, Balloon-mounted coronary stent (arrow) is successfully deployed.
C, Postprocedural ICA angiogram shows acute in-stent thrombosis (arrow).
D, Final ICA angiogram after thrombolysis with abciximab shows the MCA (arrow) with a smooth appearance, normalized luminal diameter, and preservation of the lenticulostriate arteries.
E, Angiogram at 10 months after the procedure shows asymptomatic, mild (20%) in-stent restenosis (arrow) due to intimal hyperplasia.
- Fig 3.
A 58-year-old woman with recurrent TIA and infarction symptoms involving the left MCA territories.
A, Anteroposterior left ICA angiogram shows diffuse severe stenosis (about 90%, arrow) in the total M1 portion of the right MCA.
B, Anteroposterior radiograph shows the stent (arrow) during deployment in the M1 portion.
C and D, After stent deployment, left ICA angiogram shows extravasation of contrast agent in the stent (arrow) due to a vascular tear.
E, Second stent (arrow) is inserted over the tear site.
F, Postprocedural anteroposterior left ICA angiogram shows the near-normal diameter of the vessel, with no extravasation of contrast agent (arrow).
Tables
Patient characteristics, stents used, complications, and outcomes of stenting for symptomatic MCA stenosis
Patient/Sex/Age (y) Clinical Presentation Stent (mm)* Complication Complication Management Stenosis Degree (%) Neurologic Outcome Follow-Up Initial Poststenting DSA Ischemic 1/M/48 TIA G 2.5 × 9 None NA 65 NA Fail NA NA 2/M/51 TIA G 3.0 × 9 Rupture NA 75 NA Death NA NA 3/M/71 TIA S 2.5 × 9 None NA 70 0 Excellent NA None, 25 mo 4/M/67 TIA S 2.5 × 15 AT Abciximab 8 mg IA 80 5 Excellent 6 mo, no RS None, 17 mo 5/F/74 TIA S 2.5 × 15 None NA 70 0 Excellent NA None, 17 mo 6/F/58 TIA, infarct S 2.5 × 18, S 2.5 × 12 Rupture, AT Second stent overlap, abciximab 10 mg IA 90 0 Good 10 mo RS None, 15 mo 7/M/66 TIA, infarct F 2.5 × 9 None NA 60 0 Excellent NA None, 11 mo 8/M/60 Infarct F 2.5 × 9 None NA 65 0 Excellent NA None, 11 mo 9/F/52 Infarct F 2.5 × 9 None NA 70 0 Good 6 mo, no RS None, 9 mo 10/F/49 TIA, infarct F 2.5 × 9, F 2.5 × 12 Stent jumping, AT, minor stroke Second stent overlap, abciximab 10 mg IA, IV heparin 50 0 Fair 3 mo, no RS None, 9 mo 11/M/60 TIA F 2.75 × 12 AT, SAT Abciximab 10 mg IA, IA thrombolysis 70 0 Fair 3 mo, no RS None, 9 mo 12/M/67 TIA F 2.5 × 9 AT Abciximab 10 mg IA 60 0 Good 6 mo, no RS None, 8 mo 13/M/60 TIA S 2.5 × 9 AT Abciximab 16 mg 1A 70 0 Excellent NA None, 7 mo 14/M/63 Infarct S 2.5 × 9 AT Abciximab 16 mg IA 65 0 Excellent NA None, 4 mo 15/M/41 Infarct S 2.5 × 12 None NA 60 0 Excellent NA None, 3 mo 16/F/71 TIA S 2.5 × 15 AT Abciximab 10 mg IA 60 0 Excellent NA None, 2 mo 17/M/53 Infarct S 2.5 × 12 AT Abciximab 10 mg IA 70 0 Excellent NA None, 1 mo Note.—Abbreviations: AT, acute in-stent thrombosis; F, Flexmaster (JoMed); G, Gfx (AVE; Medtronic); IA, intra-arterial; IV, intravenous; NA, not applicable; RS, in-stent restenosis; S, S660 (AVE; Medtronic); and SAT, subacute in-stent thrombosis.
* Stent implantation was successful in all patients except patient 1.
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