Cardiogenic Embolism Research Articles

Echocardiography for the Detection of Cardiac Sources of Embolism in Patients with Stroke or Transient Ischemic Attack

Transthoracic echocardiography (TTE) is commonly obtained during the evaluation of patients with ischemic stroke or transient ischemic attack (TIA) to detect potential sources of cardiogenic embolism. Specific indications for the tests remain uncertain. TTE and transesophageal echocardiography (TEE) use in routine clinical practice were assessed retrospectively in a consecutive series of patients with acute ischemic stroke to determine whether clinical features were useful in identifying those in whom echocardiography led to a change in patient evaluation or treatment. TTE identified a potential source of cardiogenic embolism in 35 of 186 (18.8%) patients, and led to a change in management in 10.8%, including anticoagulation or surgery in 5.4%. Of the 186 patients, 30 (16%) also had a TEE that identified a potential source of cardiogenic embolism in 18 (60.0%), with 33.3% subsequently having a change in evaluation or treatment. Changes in management based on TEE findings occurred in 44.4% of those with an abnormal TTE and 28.6% of those with a normal TTE. There was no association between patients' age, history of coronary heart disease, carotid stenosis, or stroke topology and the frequency of management-changing echocardiographic findings. TTE and TEE are useful for identifying management-changing potential sources of cardiogenic embolism in patients with acute ischemic stroke. Specific clinical factors increasing the yield of these tests as used in routine clinical practice, including stroke topology, could not be identified.

Unusual case of isolated biventricular non-compaction presenting with stroke

Prominent ventricular trabeculations are seen in a fetal heart. Isolated ventricular non-compaction (IVNC) is a rare form of primary cardiomyopathy. It usually presents with heart failure, arrhythmias and very rarely with thrombo-embolic manifestation. The left ventricle is involved in the majority of the cases. Echocardiography is the principal modality for the diagnosis of this condition. IVNC may be misdiagnosed as dilated or hypertrophic cardiomyopathy wherein the prognosis and management do differ significantly. We report a case of a 38-year-old male with IVNC involving both the ventricles, who presented very unusually as stroke resulting from a cardiogenic embolus.

Evaluation of Risk Factors in Elderly Patients with Cerebral Embolism Due to Nonvalvular Atrial Fibrillation

Background: Atrial fibrillation (AF) is a major risk factor for ischemic stroke. In elderly population, the incidence of cerebral embolism (CE) caused by AF tends to be increasing. In this study, we assessed the distribution and the most frequent factor in elderly patients with an embolic event due to nonvalvular AF (NVAF). Methods: Among 435 consecutive patients with cardiogenic embolus who were referred to Stroke Care Unit at our institute, 301 patients were diagnosed as CE caused by NVAF. Of the patients, 188 patients were 75 years old or more. Patients were excluded when AF episodes were not documented on electrocardiographic monitoring. The CHADS2 score was evaluated for each of the 188 patients. Results: In 75 years old or more, the CHADS2 score was 1 in 29 (15%), 2 in 62 (33%). Among patients with a CHADS2 score of 2, a combination of hypertension and age >75 years was the most frequent pattern (85%). Conclusions: The most frequent factor was hypertension in patients 75 years old or more with CE due to NVAF. The management of blood pressure is very important for preventing cerebral embolic events in elderly population with NVAF.

Factors Associated with Functional Outcomes of Patients with Cerebral Embolism Due to Nonvalvular Atrial Fibrillation

This study aimed to identify factors associated with the functional outcomes of patients with cerebral embolism due to nonvalvular atrial fibrillation. We retrospectively investigated the short-term functional outcomes of 134 patients diagnosed with cardiogenic cerebral embolism due to nonvalvular atrial fibrillation during the period of May 2006 to August 2008. Functional state was evaluated using the modified Rankin Scale (mRS) on admission and at discharge. A good functional outcome (mRS ≤2) at discharge was significantly associated with low mRS on admission (OR: 0.07; CI: 0.03-0.18; p<0.001), and a low C-reactive protein (CRP) level (OR: 0.19; CI: 0.04-0.89; p<0.05). Functional improvement during admission was positively associated with the presence of dyslipidemia (OR: 2.74; CI: 1.11-6.76; p<0.05), whereas high diastolic blood pressure (OR: 0.95; CI: 0.90-0.99; p<0.05) and a high blood sugar level (OR: 0.98; CI: 0.97-0.99; p<0.05) on admission were inversely associated with functional improvement. Furthermore, no relationship existed between mRS on admission and functional improvement during hospitalization. The results suggest that a good functional state at discharge was associated with a good functional state on admission as well as a low serum CRP level. On the other hand, functional improvement was associated with the presence of dyslipidemia, low diastolic blood pressure, and low blood sugar level on admission.

新しい抗凝固薬を巡る話題「心房細動に伴う血栓塞栓症予防と新しい抗凝固薬の役割」３．心房細動治療における新しい抗凝固薬の役割―大規模試験から実地臨床へ―

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and occurs in 1-2% of the general population. This arrhythmia is the greatest risk factor of cardiogenic embolism that has poor prognosis. Therefore anticoagulation medication is widely used for stroke prevention in atrial fibrillation (SPAF).Warfarin (WF), which is the only oral anticoagulant, has been used for more than half a century as a SPAF medication. As meta-analysis showed that WF reduced strokes in AF patients by 64%, WF has been highly recommended for stroke prevention in moderate- to high-risk AF patients.However WF is reported to be under-used. The reasons are significant management challenges including the necessities for frequent monitoring of the international normalized ratio (INR) and dose adjustment to maintain the INR within a narrow therapeutic window (2 to 3 for most indications).Today, not only in Japan but also in other regions, a new oral anticoagulant (NOAC) dabigatran, which is a thrombin inhibitor, has been approved as the first NOAC with an indication of SPAF, and an FXa inhibitor with AF indication will be marketed in the near future. Anticoagulant therapy using NOACs for SPAF is in the spotlight around the world since the RE-LY (dabigatran) and ROCKET (rivaroxaban) studies were published and substantiated either superiority or equality in efficacy and safety versus WF.In this paper, the past and current status of anticoagulant therapy in patients with atrial fibrillation will be described. Important points to note when using the new anticoagulants will also be discussed.

Local Thrombolysis for Successful Treatment of Acute Stroke in an Adolescent with Cardiac Myxoma

Intracardiac myxomas are the most common benign cardiac tumors in adults. They are a rare source of cardiogenic embolisms and sudden death, especially in young patients. This report describes the case of a male adolescent who presented with right-sided paresis and aphasia. Magnetic resonance imaging of the brain revealed an ischemic stroke without evidence of acute bleeding. Intra-arterial local thrombolysis was immediately started. An echocardiographic screening after successful thrombolysis with a remarkable recovery of symptoms detected a thrombotic-like mass in the left atrium. The mass was excised surgically, confirmed as a benign atrial myxoma, and the patient was discharged with restitution ad integrum. Thus, contrary to some critical reports, thrombolytic therapy for acute ischemic strokes due to atrial myxomas may be safe and highly effective.

Modern role for clopidogrel in management of atrial fibrillation and stroke reduction.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The prevalence of AF increases sharply in old age (prevalence approximately 10% among persons 80 years of age and older). The expected risk for ischemic stroke is increased five-fold by the presence of AF, primarily as a result of cardiogenic embolism. Multiple large-scale, randomized trials have been completed or are still underway to find optimal, efficacious, and relatively safe ways to reduce the risk of ischemic stroke and other systemic thromboembolic events related to AF. Antithrombotic strategies are accompanied by serious bleeding complications that threaten patients in need of medical stroke prevention. Treatment regimens for preventing thromboembolism in AF patients range from vitamin K antagonists such as warfarin or coumadins, antiplatelet drugs like aspirin or clopidogrel, to newly developed orally available antithrombotics like the direct thrombin inhibitor dabigatran, or the Factor Xa-inhibitor rivaroxaban. The available anticoagulant and antiplatelet drugs have different advantages and disadvantages. This review attempts to delineate the specific role of clopidogrel in patients with AF and at risk of stroke, taking into consideration new and ongoing trials in this important field of medical practice.

Ｐｕｒｅ ｍｏｔｏｒ ｉｓｏｌａｔｅｄ ｆｉｎｇｅｒ ｐａｌｓｙを呈した脳梗塞の１例

A 73-year-old man, a right-handed, has been pointed out his atrial fibrillation and seen a doctor regularly for varicose veins of left leg and hypertension. He had complaint of a sudden paralysis of his left thumb and index finger while drinking beer. The next day, there was no improvement and he was admitted to our hospital. Neurological examination revealed mild weakness of the most muscles of both thumb and index finger which were innervated by radial nerve, ulner nerve, and median nerve. But he had no any other neurological deficits including sensory system. A brain MRI revealed the acute-stage cerebral infarction in the right precentral knob. With other examinations, we diagnosed the cerebral infarction as cardiogenic embolism. Pure motor isolated finger palsy (PMIFP) in association with cerebrocortical small lesion is rare. It is probable that some cases with diagnosed of peripheral neuropathy was actually PMIFP from central nervous system disturbance.

Injury‐induced neural stem/progenitor cells in post‐stroke human cerebral cortex

Increasing evidence points to accelerated neurogenesis after stroke, and support of such endogenous neurogenesis has been shown to improve stroke outcome in experimental animal models. The present study analyses post-stroke cerebral cortex after cardiogenic embolism in autoptic human brain. Induction of nestin- and musashi-1-positive cells, potential neural stem/progenitor cells, was observed at the site of ischemic lesions from day 1 after stroke. These two cell populations were present at distinct locations and displayed different temporal profiles of marker expression. However, no surviving differentiated mature neural cells were observed by 90 days after stroke in the previously ischemic region. Consistent with recent reports of neurogenesis in the cerebral cortex after induction of stroke in rodent models, the present current data indicate the presence of a regional regenerative response in human cerebral cortex. Furthermore, observations underline the potential importance of supporting survival and differentiation of endogenous neural stem/progenitor cells in post-stroke human brain.

Stent-Assisted Recanalisation of Acute Occlusive Arteries in Patients with Acute Limb Ischaemia

To assess the efficacy of stent-assisted recanalisation for acute limb ischaemia in patients considered unfit for thrombolysis or in patients with failed surgical recanalisation. Fifteen patients with acute limb ischaemia, treated with stent implantation, were analysed retrospectively. The reasons for acute limb ischaemia were a cardiogenic embolism (n=3), a traumatic injury (n=3), acute in situ thrombosis with atherosclerosis (n=6), immediate graft thrombosis (n=2), or a delayed thrombotic occlusion after a thrombin injection in the pseudoaneurysm (n=1). This study examined the technical and clinical outcomes of the procedures, including complications during the procedural and follow-up periods. Stent-assisted recanalisation was technically successful and provided immediate recanalisation in all patients (15/15 patients, 100%) and reduced or eliminated the clinical symptoms in 12 patients (12/15 patients, 80%). Two patients died of multi-organ failure related to reperfusion injury, and one patient with a crash injury underwent a below-the-knee amputation as a result of wound necrosis despite recanalisation of the occluded bypass graft. Stent-assisted recanalisation has a high technical success rate with good clinical results as a bailout procedure for the management of acute limb ischaemia in patients, considered unfit for thrombolysis or in patients with failed surgical recanalisation.

Abstract 5127: Left Atrial Ejection Fraction (LAEF) is a Novel Marker of Left Atrial Appendage Dysfunction in Acute Stroke Patients

Background Recently, it was reported that left atrial ejection fraction (LAEF) may be as a marker of left atrial dysfunction. However, the feasibility of LAEF remains to be determined. We investigated whether LAEF is a marker of left atrial appendage (LAA) dysfunction which causes cardiogenic embolism in stroke patients. Methods We performed trans-thoracic echocardiography (TTE) and trans-esophageal echocardiography (TEE) in 53 consecutive stroke patients (cardiogenic embolism, male/female=14/9, 70±12y; stroke of other sources, male/female =21/9, 66±16y). LAEF was calculated by the biplane area-length method from apical 4- and 2-chamber views at end systolic and diastolic phase. We compared LAEF to LAA peak emptying flow velocity which is an established marker of LAA dysfunction. Results LAEF was significantly lower in patients with cardiogenic embolism than in those without it (LAEF, 30.4±11.0 vs. 45.4±14.7, P&lt;0.01). Left atrial dimensions, time and the ratio of the early diastolic trans-mitral inflow velocity (E wave), left atrial volume index (LAVI) and LAEF were significantly correlated with LAA emptying flow velocity. However, only LAEF was significantly correlated with LAA emptying flow velocity in patients with atrial fibrillation (R=0.566, p&lt;0.05). Furthermore, the multivariate logistic regression analysis revealed that only LAEF was an independent predictor of LAA dysfunction in TTE parameters (odds ratio 3.96; 95% confidence interval 1.02–15.27; P&lt;0.05). Conclusions LAEF may be a reliable non-invasive maker of LAA dysfunction and predict cardiogenic embolism in stroke patients.

Blood Pressure and Stroke in Heart Failure in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

The prevalence of stroke is increased in individuals with heart failure (HF). The stroke mechanism in HF may be cardiogenic embolism or cerebral hypoperfusion. Stroke risk increases with decreasing ejection fraction and low cardiac output is associated with hypotension and poor survival. We examine the relationship among blood pressure level, history of stroke/transient ischemic attack (TIA), and HF. We compared the prevalence of self-reported history of stroke or TIA in the REasons for Geographic And Racial Differences in Stroke (REGARDS) participants with HF (as defined by current digoxin use) and without HF. We excluded participants with atrial fibrillation or missing data. We examined the relationship between HF and history of stroke/TIA within tertiles of systolic blood pressure (SBP) adjusting for patient demographic and health characteristics. Prevalent stroke/TIA were reported by 66 (26.3%) of 251 participants with and 1805 (8.5%) of 21 202 participants without HF (P<0.0001). Within each tertile of SBP, the unadjusted OR (95% CI) for prior stroke/TIA among those with HF compared with those without HF (the reference group) was, 4.0 (2.8 to 5.8) for SBP <119.5 mm Hg, 2.7 (1.8 to 3.9) for SBP >or=119.5 but <131.5 mm Hg, and 2.3 (1.6 to 3.2) for SBP >or=131.5 mm Hg. After adjustment, the relationship between prior stroke/TIA and HF remained significant only within the lowest tertile of SBP (<119.5 mm Hg; 3.0; 1.5 to 6.1). The odds of prevalent self-reported stroke/TIA are increased in participants with HF and most markedly increased in participants with low SBP. Longitudinal data are needed to determine whether this reflects stroke/TIA secondary to thromboembolism from poor cardiac function or secondary to cerebral hypoperfusion.

Secondary Prevention in Concurrent Coronary Artery, Cerebrovascular, and Chronic Kidney Disease: Focus on Pharmacological Therapy

Patients with coronary artery disease (CAD) commonly have varying degrees of coexisting cerebrovascular disease (CVD) and chronic kidney disease (CKD), and proper management is complicated partly because of a lack of unifying guidelines. The aim of this article is to review the current literature and propose the optimal treatment regimen in patients with all three disease states. Angiotensin-converting enzyme inhibitors (ACE-I) should be universally administered. High-dose statin therapy to reach a target low-density lipoprotein (LDL) of 70-100 mg/dL is advocated, although patients with a history of cerebral bleeding must be carefully monitored for possible recurrence. Beta-blockers are appropriate after a recent coronary event, and amlodipine or thiazide diuretics should be used after a recent stroke (within 6 months). Patients with a history of stroke (with or without coexisting CAD and CKD) should receive aspirin (75-150 mg/day) indefinitely. Clopidogrel or aspirin plus extended-release dipyridamole (ER-DP) may be prescribed in patients allergic or resistant to aspirin. If stroke is attributable to cardiogenic embolism, anticoagulation is indicated. In patients with acute coronary syndromes (ACS) (excluding ST-elevated myocardial infarct) who undergo percutaneous coronary intervention (PCI), aspirin plus clopidogrel is indicated for secondary prevention for up to 12 months. There are no data supporting the use of aspirin plus clopidogrel in patients with CKD who develop ACS. Aspirin plus clopidogrel is contraindicated for stroke prevention.

Posterior Cerebral Artery Infarction: Diffusion-Weighted MRI Analysis of 205 Patients

Background and Purpose: Although cardiac embolism has been shown to be the leading stroke mechanism of posterior cerebral artery (PCA) territory infarction, intrinsic PCA atherosclerotic disease may play a more important role in regions where intracranial diseases are prevalent. We aimed to assess the etiologies and stroke pattern of PCA territory infarction in a Korean population. Method: We reviewed consecutive patients with acute PCA territory infarction who underwent diffusion-weighted MRI (DWI) and magnetic resonance angiography (MRA) within 7 days after onset. Results: A total of 205 patients (male 56%, mean age 65.4 ± 12.4 years) were recruited. ‘Superficial’, ‘deep’ and ‘superficial plus deep’ infarcts accounted for 26.3, 47.8 and 25.9% of infarcts, respectively. There were 126 patients who had infarcts limited to the PCA territory, whereas 79 patients had concomitant infarcts in other territories. Large artery atherosclerosis (LAA, 42.4%) was the most frequent etiology, followed by cardiogenic embolism (20%), small-vessel occlusion (20%), undetermined (18%) and other determined (3%) etiology. Among the 87 patients with LAA, 38 had intrinsic PCA disease without atherosclerosis in the proximal vessels. In these patients, stroke mechanisms included atheromatous branch occlusion (n = 19), in situ thrombotic occlusion (n = 11) and artery-to-artery embolism (n = 8). While the occipital area was the most frequently involved in general, the ventrolateral thalamic area was more frequently involved than the occipital area in patients with intrinsic PCA atherosclerotic disease. Conclusion: The patterns of PCA territory infarction are different according to underlying etiologies. In our population, intrinsic atherosclerotic disease is a relatively important cause of PCA territory infarction that produces strokes through a variety of mechanisms.

Sneddon's syndrome

The risk of recurrence of stroke in patients with systemic lupus erythematosus (SLE) is much higher than in other stroke patients, and the preventative treatment is influenced by the underlying systemic disease. Microinfarcts and microhemorrhages are seen frequently in autopsy specimens of SLE patients. Asymptomatic microinfarcts are common, and are now diagnosed due to the high sensitivity of MRI. Occlusions of large arteries and major strokes also occur in lupus patients. Atherosclerosis may be more frequent in SLE patients than in the general population. The major causes of stroke in lupus are cardiogenic emboli and hypercoagulable (including hypofibrinolytic) states, and the mainstay of stroke prevention is long-term warfarin, with an international normalized ratio (INR) of approximately 3.0. Although stroke is an important problem in lupus patients, leading to significant morbidity in young patients, SLE is relatively uncommon in young patients presenting with strokes or transient ischemic attacks (TIAs).

Evaluation of costs and outcome in cardioembolic stroke or TIA

The costs of acute stroke care, length of hospital stay (LOS), and outcome in patients with cardioembolic stroke or cardioembolic transient ischemic attacks (TIA) were investigated with the aim of estimating the clinical and health-economic impacts of cerebral cardioembolism. The study population consisted of 511 consecutive patients with the diagnosis of ischemic stroke (n = 379) or TIA (n = 132) treated at the Department of Neurology, Philipps University, Marburg. Cerebral cardioembolism was defined according to the criteria of the Cerebral Embolism Task Force. Clinical status was assessed by means of Barthel index (BI) and modified Rankin Scale. Costs were calculated using a bottom-up approach. All costs (in Euros) were inflated to the 2008 level. Compared to non-cardioembolic stroke (n = 278) patients, patients who had suffered cardioembolic stroke (n = 101) had more severe clinical deficits on admission (BI 46.3 +/- 27.0 vs. 59.3 +/- 34.1; P < 0.01), worse recovery (BI on discharge 59.2 +/- 28.9 vs. 73.1 +/- 33.4; P < 0.01), and increased LOS (12.6 +/- 5.7 vs. 10.0 +/- 7.8 days; P < 0.01). The latter also required a relatively higher daily resource utilization due to increased expenses for personnel and diagnostics. Mean costs of acute care for patients with cardioembolic stroke [euro 4890 per patient (95% confidence interval 4460-5200)] were significantly higher than those for patients with non-cardioembolic stroke [euro 3550 (95% confidence interval 3250-3850); P < 0.01]. The clinical and health-economic impact of cardiogenic cerebral embolism on stroke care is considerable. Patients with cardioembolic stroke/TIA are more severely impaired, and they require longer hospital treatment and increased resource utilization. Costs of acute care of cardioembolic stroke/TIA patients may exceed those of non-cardioembolic stroke/TIA by up to 40%.

Specific cardiological evaluation after focal cerebral ischemia.

Purpose of this study was to define a subgroup of TIA/stroke patients who should be examined by transthoracal and transesophageal echocardiography or Holter-electrocardiography to identify those with cardiogenic brain embolism reliably; 300 consecutive patients with acute focal brain ischemia underwent a standardized diagnostic protocol for the evaluation of the etiology including, clinical examination by a cardiologist and routine electrocardiography, Holter-electrocardiography, transthoracal and transesophageal echocardiography. 188 patients had a potential cardiac source of embolism. In particular echocardiography was diagnostic in 163 patients, and Holter-electrocardiography 10; 159 of these 188 patients (84.6%) had competitive etiologies, predominantly large vessel atherosclerosis. In 136 patients cardiogenic brain embolism was assumed as quite definite or possible. To identify these patients reliably, transthoracal and transesophageal echocardiography would have been necessary in 89% of the entire group of patients (all with clinically cardiological abnormalities, pathological routine ECG, without vascular risk factors, or no atherosclerosis in duplex sonography), and Holter-electrocardiography in 54%.

Early outcome and recurrences after cardiogenic brain embolism.

Functional outcome and recurrence rate were evaluated retrospectively in a series of 566 consecutive patients with a cardioembolic TIA or stroke. Seventy-five patients had a TIA/RIND, 163 a minor stroke, 238 a major deficit, and 90 a fatal event. In a logistic regression analysis the probability of a disabling or fatal outcome was significantly influenced by age (p = 0.0023), a previous stroke (p = 0.0262), concomitant carotid artery disease in Doppler sonography (p = 0.0210), and the underlying heart disease (p = 0.0001). Fatal or major strokes predominated among patients with nonvalvular atrial fibrillation, prosthetic heart valves, acute or chronic myocardial infarction. Kaplan-Meier estimates revealed a cumulative risk of recurrent cerebral embolism of 2.9% within three weeks. In a proportional hazards model only the underlying heart disease was significantly linked with the risk of recurrent embolism (p = 0.021).

Paediatric stroke

The past decade has seen a dramatic increase in pediatric stroke research. However few studies have addressed antithrombotic safety or effectiveness. Three paediatric stroke guidelines combining research data with expert consensus have been published in the past five years. For most patients treatment recommendations are consistent. Newborns with arterial ischaemic stroke (AIS) rarely require antithrombotic treatment given their extremely low risk of recurrence. In children with AIS a substantial recurrence risk means that antithrombotic treatment is required unless contraindicated. Anticoagulation (heparins, warfarin) is recommended for possible or established dissection and cardiogenic embolism. Antiplatelet treatment is recommended for other children with AIS. For neonatal cerebral sinovenous thrombosis (CSVT) most centers provide initial anticoagulation in the absence of haemorrhagic contra indications, and otherwise, monitor for propagation. Children with CSVT, even with haemorrhagic infarction, more consistently receive anticoagulation, as in adults. While more studies are necessary, current treatment guidelines offer an interim option for guiding the treatment of paediatric stroke.

Primary Stent Placement of an Acute Occlusion in the Iliac Arteries of Patients with Acute Limb Ischemia

Purpose: To assess the efficacy of stent-assisted recanalization for the management of acute limb ischemia (ALI) after a failed surgical revascularization in patients with acute iliac arterial occlusion and considered unfit for a thrombolysis. Materials and Methods: The data on 6 patients with acute limb ischemia due to iliac arterial occlusion, and treated with stent implantation between November 2005 and March 2008, was analyzed retrospectively. The reasons for ALI in the patients analyzed included acute thrombosis related to a traumatic injury (n=3), acute in-situ thrombosis with pre-existing atherosclerotic stenosis (n=2), and cardiogenic embolism (n=1). A preprocedural CT angiography and conventional angiography revealed an occlusion at the iliac artery. This study examined the clinical data, technical and clinical outcome of the procedure, and complications related to the procedure or follow-up period for each patient. Results: Primary stenting was technically successful in all patients, thus resulting in the reduction or elimination of clinical symptoms in the 5 patients observed. One patient expired due to multi-organ failure related to a reperfusion injury. The other five patients showed good clinical results without symptom recurrence and normal duplex USG or CT angiographic findings during the 3-15 month follow-up period. Conclusion: A stent-assisted recanalization is an effective treatment for patients with ALI, which are considered unfit for thrombolysis and surgical recanalization.