Transluminal Angioplasty for Middle Cerebral Artery Stenosis in Patients with Acute Ischemic Stroke

• Published in: American journal of neuroradiology : AJNR 1999-04, Vol.20 (4), p.553-558
• Main Authors: Suh, Dae Chul, Sung, Kyu-Bo, Cho, Yong Soo, Choi, Choong Gon, Lee, Ho Kyu, Lee, Jae Hong, Kim, Jong Sung, Lee, Myoung Chong
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Angioplasty, Balloon - instrumentation; Angioplasty, Balloon - methods; Anticoagulants - therapeutic use; Arterial Occlusive Diseases - complications; Arterial Occlusive Diseases - therapy; Biological and medical sciences; Blood Flow Velocity - physiology; Brain Ischemia - etiology; Brain Ischemia - therapy; Carotid Artery, Internal - pathology; Cerebral Angiography; Cerebral Arterial Diseases - complications; Cerebral Arterial Diseases - therapy; Cerebrovascular Circulation - physiology; Cerebrovascular Disorders - etiology; Cerebrovascular Disorders - therapy; Drug Resistance; Equipment Design; Female; Follow-Up Studies; Humans; Interventional; Ischemic Attack, Transient - etiology; Ischemic Attack, Transient - therapy; Male; Medical sciences; Middle Aged; Neurology; Platelet Aggregation Inhibitors - therapeutic use; Recurrence; Safety; Tomography, Emission-Computed, Single-Photon; Tropical medicine; Ultrasonography, Doppler, Transcranial; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0195-6108; 1936-959X

Precutaneous transluminal angioplasty (PTA) is currently performed to treat supraaortic atherosclerotic lesions. Our purpose was to evaluate the safety and efficacy of PTA for middle cerebral artery (MCA) stenosis in patients with acute ischemic stroke. We performed PTA with the use of a microballoon (2-2.5 mm in diameter and 10-13 mm in length) in 10 consecutive patients (mean age, 48 years) who met the following criteria: high-grade M1 stenosis (> 70%) and mild neurologic deficits (NIH stroke scale < 4) and/or recurrent transient ischemic attacks (TIAs) resistant to anticoagulation, or a large area of hypoperfusion in the MCA territory on brain perfusion SPECT scans. During follow-up, we administered antiplatelet agents and evaluated the status of restenosis by angiography (n = 2), brain perfusion SPECT (n = 4), and/or transcranial Doppler sonography (TCD) (n = 7). Stenotic arteries were successfully dilated in nine of 10 patients. Angioplasty failed in one patient because the balloon could not pass through the tortuous cavernous internal carotid artery. None of the patients experienced either peri- or postangioplasty complications. Residual stenosis was less than 50%, and clinical improvement, including elimination of TIAs in four patients who had suffered resistant TIAs, was observed in all patients; improvement of the cerebral perfusion was also noted in two patients with a large hypoperfusion area in the MCA territory. The average follow-up period was 11 months (range, 2 to 36 months). None experienced recurrent stroke during the follow-up period. TCD revealed decreased flow velocity of the MCA after angioplasty in seven patients. PTA of the proximal portion of the MCA seems to be a safe and effective therapeutic technique for the prevention of secondary ischemic stroke.