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.
Georg Thieme Verlag KG Stuttgart · New York.