Document Detail

The effectiveness of microballoon angioplasty in treating middle cerebral artery occlusion beyond the bifurcation.
MedLine Citation:
PMID:  20538827     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: PTA effectively treats vasospasm and arterial disease in peripheral, coronary, and large proximal cerebral vessels but rarely reaches small vessels like the distal MCA beyond the bifurcation. Our purpose was to evaluate the safety and efficacy of PTA for distal MCA occlusions in acute ischemic stroke.
MATERIALS AND METHODS: Seven patients had strokes in branches of their MCAs. Following diagnostic angiography, all received microballoon angioplasty and various combinations of IA alteplase (rtPA), abciximab, and/or nitroglycerin. Two also underwent stent placement. Comprehensive retrospective review of the patients' records was performed. Patients' NIHSS scores were reassessed before discharge. Recanalization was evaluated by angiography after treatment and at follow-up.
RESULTS: PTA was successfully performed in 7 patients without treatment-associated intracerebral hemorrhage. Two patients received distal MCA angioplasty as a secondary intervention: 1 following failed treatment with a Merci retriever and the other after successful removal of proximal clot with a Merci retriever. One patient did not recover from the initial ischemic event despite an excellent angiographic result. Complete recanalization (modified TIMI grade 4) was achieved in 4 patients and near-complete recanalization with mild flow deficit (modified TIMI grade 3), in 3 patients.
CONCLUSIONS: PTA of the distal MCA with a microballoon is safe and effective for acute ischemic stroke. This case series demonstrates that endovascular treatment beyond the MCA bifurcation can dramatically reverse neurologic deficits.
E Gifford; D Drazin; J C Dalfino; A K Nair; J Yamamoto; A S Boulos
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-06-10
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  31     ISSN:  1936-959X     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-13     Completed Date:  2011-01-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1541-8     Citation Subset:  IM    
Division of Neurosurgery, Albany Medical Center, Albany, NY, USA.
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MeSH Terms
Acute Disease
Aged, 80 and over
Angioplasty, Balloon / methods*
Brain Ischemia / radiography,  therapy*
Cerebral Angiography
Cerebral Revascularization / methods*
Follow-Up Studies
Infarction, Middle Cerebral Artery / radiography,  therapy*
Middle Aged
Retrospective Studies

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