Case Courtesy Dr. Eytan Raz
Another case of acute stenting when thrombectomy fails — an underutilized technique when we know how bad it is to leave the M1 closed. Here is another example (see one here also)
M1 occlusion, inferior division already shows signs of ischemia. The superior division still seems salvageable
Culprit lesion at bifurcation of dominant superior division MCA
Angio shows bare minimum of superior division flow
Just like CTA
Post Solitaire. Not much better
Post plasty is worse, as happens not too rarely. Cant plasty unless you are ready to stent
Wire access is kept on purpose
A Promus stent is deployed. The guide is a simple VERT 5F catheter. Commodity-style. This stent costs far less than a Neuroform, Atlas, or Wingspan. It is as easy to track as a noncompliant balloon of similar size and simple to deploy. We prefer off-label balloon-mounted stents for all intracranial stenting.
Post angio. The snowplow effect has almost closed the already infarcted small inferior division M2, while dominant superior division looks perfect
24 hour CT
Check out another similar case here.
Baek JH, Kim BM, Kim DJ, Heo JH, Nam HS, Yoo J. Stenting as a Rescue Treatment After Failure of Mechanical Thrombectomy for Anterior Circulation Large Artery Occlusion. Stroke. 2016 Sep;47(9):2360-3.
Chang Y1, Kim BM2, Bang OY1, Baek JH1, Heo JH1, Nam HS1, Kim YD1, Yoo J1, Kim DJ1, Jeon P1, Baik SK1, Suh SH1, Lee KY1, Kwak HS1, Roh HG1, Lee YJ1, Kim SH1, Ryu CW1, Ihn YK1, Kim B1, Jeon HJ1, Kim JW1, Byun JS1, Suh S1, Park JJ1, Lee WJ1, Roh J1, Shin BS1, Kim JM1 Rescue Stenting for Failed Mechanical Thrombectomy: A Multicenter Experience. Stroke 2018