Emergent intracranial stenting for acute M2 occlusion of middle cerebral artery.

OBJECTIVE: Intracranial stenting is a possible option as a rescue strategy for acute secondary division (M2) occlusion of middle cerebral artery (MCA) when intravenous thrombolysis is ineffective or contraindicated.

METHODS: We reviewed 10 patients of acute M2 occlusion treated by intracranial stenting who were ineligible for intravenous thrombolysis or resistant to intravenous thrombolysis. All patients underwent intracranial stenting with the Wingspan stent system. We analyzed clinical and angiographic outcomes.

RESULTS: The mean NIHSS score on admission was 13.8 points (range 6-23). The occlusion sites were located in the superior division (n=4, left: 3, right: 1), the middle division (n=1, right) and the inferior division (n=5, all: right) of MCA. The mean time interval from stroke symptom onset to stenting was 348.9 ± 90.4 min. Successful recanalization was achieved in all patients. No intracranial hemorrhage, vessel perforations or dissections occurred in any patient. One patient developed acute thrombosis in distal ICA of the stented side at 4 days after a stent placement and was managed with mechanical thrombectomy. All patients improved on the NIHSS (mean amount: 8.8) and to the NIHSS score of 5 ± 4.6 (median 4.5, range 0-15) at 7 days. At discharge, an mRS of ≤ 3 was achieved in 8 patients (80%) and an mRS of ≤ 2 was achieved in 6 patients (60%).

CONCLUSIONS: Endovascular recanalization with a Wingspan stent can be a safe and feasible procedure for acute M2 occlusion when intravenous thrombolysis is ineffective or not available.