J Korean Soc Radiol.  2017 Jun;76(6):403-410. 10.3348/jksr.2017.76.6.403.

Emergent Intracranial Balloon Angioplasty and Bailout Self-Expandable Stent Placement in Acute Large Vessel Occlusion of the Anterior Circulation: Experience of a Single Institution

• Heo YJ
• Seo JH
• Jeong HW

• KMID: 2379322
• DOI: http://doi.org/10.3348/jksr.2017.76.6.403

Abstract

PURPOSE
To evaluate the outcomes of angioplasty for recanalization after acute ischemic stroke (AIS).
MATERIALS AND METHODS
The study population was selected from 134 patients who underwent endovascular revascularization therapy (ERT) for AIS between October 2011 and May 2014. Of those 134 patients, 39 who underwent balloon angioplasty with or without stent insertion were included in this study. Balloon angioplasty was the primary treatment for nine patients and a rescue method for 30 patients. The revascularization rate at 7 days, procedure-related complications, and clinical outcomes at 3 months were analyzed.
RESULTS
The occlusion sites were the middle cerebral artery (n = 26), intracranial internal carotid artery (n = 10), and middle cerebral artery branch (n = 3). Angioplasty achieved successful revascularization (Thrombolysis in Cerebral Ischemia grade 2b-3) in 76.9% of patients. Computed tomography angiography performed 7 days post-procedure revealed a maintained reperfusion in 82.8% of successful cases. Only two patients had symptomatic intracerebral hemorrhage. At the 3-month follow-up, 18 (48.6%) and 10 (27.0%) patients showed good and poor functional outcomes, respectively (modified Rankin Scale scores, 0-2 and 5-6).
CONCLUSION
Emergent balloon angioplasty and bailout self-expandable stent placement may be safe and effective for achieving successful revascularization in acute large vessel occlusion of the anterior circulation. It could be a feasible rescue method as well as a primary method for ERT.

MeSH Terms

Angiography
Angioplasty
Angioplasty, Balloon*
Brain Ischemia
Carotid Artery, Internal
Cerebral Hemorrhage
Follow-Up Studies
Humans
Methods
Middle Cerebral Artery
Reperfusion
Stents*
Stroke

Figure

• 

  Fig. 1 Tirofiban was administered to restore blood flow for re-thrombosis after angioplasty. An 81-year-old man who presented with multifocal middle cerebral artery territory infarction on diffusion weighted magnetic resonance imaging (A), shows left proximal M1 stenosis on MR angiography (B). Gateway balloon angioplasty (C) and Wingspan stent insertion (D) were performed, but in-stent thrombosis persisted. Thus, tirofiban was administered to restore blood flow, and post-stent balloon angioplasty (E) was performed.

• 

  Fig. 2 Angioplasty was performed as a rescue method after failure of a Solitaire stent for mechanical thrombectomy. A 55-year-old man with left hemiparesis shows right middle cerebral artery (MCA) territory infarction on diffusion weighted imaging (DWI) (A), and a severe steno-occlusive lesion involving the right M1 segment (B) on angiography. After several trials of thrombus retrieval using Solitaire stents, only partial recanalization was achieved (C). A Gateway catheter and Wingspan stent were used for balloon angioplasty (D). However, progression of an in-stent thrombus is noted on delayed angiography (E). Thus, tirofiban was infused and the thrombus decreased (F).

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