• Takuya Fukuoka, Tomohisa Dembo, Harumitu Nagoya, Ichiro Deguchi, Hajime Maruyama, Ryuzaburo Kanazawa, Shinya Kohyama, Fumitaka Yamane, Shoichiro Ishihara, and Norio Tanahashi.
• Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan. tfukuoka@saitama-med.ac.jp
• J Stroke Cerebrovasc Dis. 2012 Nov 1; 21 (8): 883-9.

BackgroundRevascularization with emergency stent placement in patients with acute middle cerebral artery occlusion is still controversial in Japan.MethodsWe placed balloon-expandable coronary bare stents in 3 patients in whom revascularization was not obtained after intravenous tissue plasminogen activator therapy (IV t-PA) for acute ischemic stroke (middle cerebral artery M1 occlusion).ResultsPatient 1 was an 87-year-old woman with left hemiplegia. Her National Institutes of Health Stroke Scale score (NIHSS) was 12, and her magnetic resonance imaging diffusion-weighted image Alberta Stroke Programme Early Computed Tomography Score (MRI DWI-ASPECTS) was 8. Adequate revascularization was not obtained with IV t-PA and adjunctive percutaneous transluminal angioplasty (PTA) for right M1 occlusion, and a stent was placed 368 minutes after onset. Her Thrombolysis in Myocardial Infarction Trial (TIMI) score was 2. After 90 days, her modified Rankin scale (mRS) score was 4. Patient 2 was a 65-year-old woman with left hemiplegia. Her NIHSS score was 16, and MRI DWI-ASPECTS was 9. A stent was placed 337 minutes after onset after IV t-PA and adjunctive PTA for right M1 occlusion. Her TIMI score was 3. After 90 days, her mRS score was 3. Patient 3 was a 61-year-old woman with left hemiplegia. Her NIHSS score was 18, and MRI DWI-ASPECTS score was 7. Arterial dissection was found after IV t-PA and adjunctive PTA for the right M1 occlusion, so a stent was placed 312 minutes after onset. Her TIMI score was 2. After 90 days, her mRS score was 0.ConclusionsRevascularization with emergency stent placement seems likely to be successful in patients with acute middle cerebral artery occlusion, but clinical symptoms do not always improve in some cases and care is needed in selecting patients for the procedure.Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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