Balloon-expandable stents for treatment of symptomatic middle cerebral artery stenosis: Clinical outcomes during long-term follow-up. Baik Sung Hyun,Kwak Hyo Sung,Chung Gyung Ho,Hwang Seung Bae Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences BACKGROUND:Insertion of a balloon-expandable stent (BES) in patients with symptomatic intracranial atherosclerosis is a treatment option for reperfusion therapy. In this study, we retrospectively reviewed clinical outcomes during long-term follow-up after insertion of balloon-expandable stents in patients with symptomatic middle cerebral artery (MCA) stenosis. METHODS:Institutional review board approval was obtained for retrospective review of patient data. Thirty-four patients (15 men, 19 women; median age, 67.5 years) with symptomatic MCA stenosis underwent balloon-expandable stent insertion between June 2008 and December 2010. Patient records were reviewed for angiographic findings and clinical outcomes during long-term follow-up. RESULTS:Of these patients, 22 presented with acute ischemic stroke with underlying MCA atherosclerosis and had good clinical outcomes (modified Rankin Scale score (mRS): 0-2) after reperfusion therapy. Indications for stenting for the remaining 12 patients were recurrent transient ischemic attacks (TIAs) refractory to medical therapy and MCA stenosis greater than 70%. During the poststenting follow-up period, which ranged from 61 to 108 months (median, 67.5 months), a TIA occurred in five patients. Of these five patients, one experienced a complete reocclusion of the MCA stent, and three had symptomatic restenosis. The remaining 29 patients did not experience any further ischemic events or restenosis during the follow-up period. CONCLUSIONS:In our study, treatment with balloon-expandable stents in patients with symptomatic MCA stenosis resulted in low recurrence rates for both ischemic events and restenosis during long-term follow-up. 10.1177/1591019918786515

Angiographic pattern of symptomatic severe M1 stenosis: comparison with presenting symptoms, infarct patterns, perfusion status, and outcome after recanalization. Choi Jin Woo,Kim Jae Kyun,Choi Byung Se,Lim Hyun-Kyung,Kim Sang Joon,Kim Jong Sung,Suh Dae Chul Cerebrovascular diseases (Basel, Switzerland) BACKGROUND:Several angiographic patterns distal to severe M1 stenosis have been identified. We have assessed the relationship between these angiographic patterns and patient presenting symptoms, infarct patterns, perfusion status and outcome after recanalization. METHODS:Three angiographic patterns were retrospectively identified in 60 patients (M:F = 41:19; age range = 34-80 years, mean = 55) who underwent M1 stenting: (1) a normal pattern (n = 22); (2) a shift pattern of the borderzone of the anterior cerebral artery (ACA) and middle cerebral artery (MCA) down to the MCA side with decreased size of MCA branches (n = 16), and (3) a dilatation pattern of the MCA branches with slow flow and minimal shift of borderzone (n = 22). In addition, to analyze interreader agreement, we assessed the correlation between angiographic patterns and gender, presenting symptoms (stroke vs. TIA), infarct patterns on MRI (borderzone vs. non-borderzone infarcts), perfusion results and outcome after stenting by chi(2) or Fisher's exact test. RESULTS:Blind review revealed an excellent interreader agreement in the assessment of angiographic patterns (kappa = 0.681). The shift pattern was more common in women than in men (p = 0.007). The likelihood of stroke (25/60, 42%, p = 0.001), borderzone infarct (21/32, 66%, p = 0.010) and decreased perfusion (p < 0.001) were greatest in the dilatation pattern, followed by shift and normal patterns. The outcomes did not differ by angiographic pattern probably due to the low event rate (4/60, 6.7%) within 6 months. CONCLUSIONS:Patients with severe M1 stenosis had 3 different angiographic patterns, which correlated with presenting symptoms, infarct patterns and perfusion status. Differences in patterns may be related to variation in collateral circulation at the ACA-MCA borderzone and hypoperfusion status. 10.1159/000275508