Subacute Percutaneous Cerebral Balloon Angioplasty for Middle Cerebral Artery Occlusion in Patients with Internal Border Zone Infarcts.

Abstract

Background We report our initial experiences of subacute percutaneous cerebral balloon angioplasty (PTCBA) for atherothrombotic middle cerebral artery (MCA) occlusion in patients with internal border zone (IBZ) infarcts more than 1 week after stroke onset. Methods Included in the retrospective analysis were patients (1) who were admitted to our institution between 3 and 72 hours after an atherothrombotic stroke onset, (2) whose diffusion-weighted image at admission showed small high-intensity lesions in the IBZ area, (3) whose magnetic resonance angiography at admission displayed the MCA occlusion, (4) whose computed tomography scans on day 7 showed the IBZ infarcts, (5) whose National Institutes of Health Stroke Scale (NIHSS) score was ≥ 10 on day 7, and (6) whose neurologic symptoms deteriorated day by day within 7 days of onset (a > 4-point increase on the NIHSS) despite medical therapy. Results Ten patients met our criteria and were informed of their treatment options including angioplasty and/or stenting for atherothrombotic MCA occlusion in a subacute stroke stage. Four patients gave written informed consent and underwent subacute PTCBA; six did not. Although there were no significant differences in the prestroke modified Rankin Scale (mRS), NIHSS on admission and NIHSS on day 7 after onset between the two groups, 3-month mRS score (median) was 3 in the PTCBA group and 5 in the medical treatment group (p < 0.05). Conclusion Subacute PTCBA for atherothrombotic MCA occlusion may be effective in improving long-term clinical outcome in patients with IBZ infarcts.