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
Solitaire
Post Solitaire. Not much better
Attempting angioplasty
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
Post angio. The snowplow effect has almost closed the already infarcted small inferior division M2, while dominant superior division looks perfect
Global views
24 hour CT
Check out another similar case here.
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