Emergent angioplasty and stent placement recanalization without thrombolysis in acute middle cerebral artery occlusions

A significant proportion of patients with infarcts from large-vessel lesions have shown a poor response to systemic thrombolysis. Stents have been used to recanalize occluded or severely stenosed intracranial arteries in patients with acute stroke. This study evaluated the feasibility, efficacy, and safety of intracranial artery recanalization for acute middle cerebral artery (MCA) occlusion using emergent angioplasty and stent placement without thrombolysis. All patients from a retrospectively collected database who met the inclusion criteria and were treated with an intracranial stent for acute MCA occlusion were included. Treatment comprised angioplasty and stenting without interventional thrombolytic therapy. Recanalization was assessed by angiography immediately after stent placement based on the Thrombolysis in Myocardial Infarction (TIMI) score. Complications related to the procedure and outcomes were assessed. Neurologic status was evaluated before and after treatment. Eleven patients were treated with emergent angioplasty and stent placement. Partial or complete recanalization (TIMI 2 and 3) was achieved in 11 patients (100%) assessed by digital subtraction angiography immediately after MCA stenting. One patient died due to reocclusion of MCA 2 days after the procedure. Among the survivors, 7 patients (70%) had a good outcome (modified Rankin Scale score, 0-2) and 3 patients (30%) had a moderate outcome (modified Rankin Scale score, 3). Follow-up computed tomography angiography or magnetic resonance angiography revealed mild restenosis in 2 of the 10 patients. This preliminary experience demonstrates the technical feasibility and high rate of recanalization with emergent angioplasty and stenting without thrombolysis in patients with acute MCA occlusion.