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<meta name="DC.Title" content="The Effectiveness of Microballoon Angioplasty in Treating Middle Cerebral Artery Occlusion Beyond the Bifurcation" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2099" />
<meta name="DC.Date" content="2010-09-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: PTA effectively treats vasospasm and arterial disease in peripheral, coronary, and large proximal cerebral vessels but rarely reaches small vessels like the distal MCA beyond the bifurcation. Our purpose was to evaluate the safety and efficacy of PTA for distal MCA occlusions in acute ischemic stroke.

MATERIALS AND METHODS: Seven patients had strokes in branches of their MCAs. Following diagnostic angiography, all received microballoon angioplasty and various combinations of IA alteplase (rtPA), abciximab, and/or nitroglycerin. Two also underwent stent placement. Comprehensive retrospective review of the patients' records was performed. Patients' NIHSS scores were reassessed before discharge. Recanalization was evaluated by angiography after treatment and at follow-up.

RESULTS: PTA was successfully performed in 7 patients without treatment-associated intracerebral hemorrhage. Two patients received distal MCA angioplasty as a secondary intervention: 1 following failed treatment with a Merci retriever and the other after successful removal of proximal clot with a Merci retriever. One patient did not recover from the initial ischemic event despite an excellent angiographic result. Complete recanalization (modified TIMI grade 4) was achieved in 4 patients and near-complete recanalization with mild flow deficit (modified TIMI grade 3), in 3 patients.

CONCLUSIONS: PTA of the distal MCA with a microballoon is safe and effective for acute ischemic stroke. This case series demonstrates that endovascular treatment beyond the MCA bifurcation can dramatically reverse neurologic deficits.

AMC
:   Albany Medical Center
AP
:   anteroposterior
CTA
:   CT angiography
ED
:   emergency department
HH
:   Hunt and Hess
IA
:   intra-arterial
ICA
:   internal carotid artery
Intra
:   drugs delivered between treatments
IV
:   intravenous
L
:   left
MCA
:   middle cerebral artery
mRS
:   modified Rankin Score
NIHSS
:   National Institutes of Health Stroke Scale
Post
:   drugs delivered following mechanical treatment
Pre
:   spasmolytic agents delivered prior to mechanical treatment
PTA
:   percutaneous transluminal angioplasty
R
:   right
RHF
:   right-handed female
rtPA
:   recombinant tissue plasminogen activator
TIMI
:   Thrombolysis in Myocardial Infarction" />
<meta name="DC.Contributor" content="E. Gifford" />
<meta name="DC.Contributor" content="D. Drazin" />
<meta name="DC.Contributor" content="J.C. Dalfino" />
<meta name="DC.Contributor" content="A.K. Nair" />
<meta name="DC.Contributor" content="J. Yamamoto" />
<meta name="DC.Contributor" content="A.S. Boulos" />
<meta name="article:published_time" content="2010-09-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="The Effectiveness of Microballoon Angioplasty in Treating Middle Cerebral Artery Occlusion Beyond the Bifurcation" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;PTA effectively treats vasospasm and arterial disease in peripheral, coronary, and large proximal cerebral vessels but rarely reaches small vessels like the distal MCA beyond the bifurcation. Our purpose was to evaluate the safety and efficacy of PTA for distal MCA occlusions in acute ischemic stroke.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Seven patients had strokes in branches of their MCAs. Following diagnostic angiography, all received microballoon angioplasty and various combinations of IA alteplase (rtPA), abciximab, and/or nitroglycerin. Two also underwent stent placement. Comprehensive retrospective review of the patients9 records was performed. Patients9 NIHSS scores were reassessed before discharge. Recanalization was evaluated by angiography after treatment and at follow-up.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;PTA was successfully performed in 7 patients without treatment-associated intracerebral hemorrhage. Two patients received distal MCA angioplasty as a secondary intervention: 1 following failed treatment with a Merci retriever and the other after successful removal of proximal clot with a Merci retriever. One patient did not recover from the initial ischemic event despite an excellent angiographic result. Complete recanalization (modified TIMI grade 4) was achieved in 4 patients and near-complete recanalization with mild flow deficit (modified TIMI grade 3), in 3 patients.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;PTA of the distal MCA with a microballoon is safe and effective for acute ischemic stroke. This case series demonstrates that endovascular treatment beyond the MCA bifurcation can dramatically reverse neurologic deficits.&lt;/p&gt;" />
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<meta name="twitter:title" content="The Effectiveness of Microballoon Angioplasty in Treating Middle Cerebral Artery Occlusion Beyond the Bifurcation" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: PTA effectively treats vasospasm and arterial disease in peripheral, coronary, and large proximal cerebral vessels but rarely reaches small vessels like the distal MCA beyond the bifurcation. Our purpose was to evaluate the safety and efficacy of PTA for distal MCA occlusions in acute ischemic stroke.

MATERIALS AND METHODS: Seven patients had strokes in branches of their MCAs. Following diagnostic angiography, all received microballoon angioplasty and various combinations of IA alteplase (rtPA), abciximab, and/or nitroglycerin. Two also underwent stent placement. Comprehensive retrospective review of the patients' records was performed. Patients' NIHSS scores were reassessed before discharge. Recanalization was evaluated by angiography after treatment and at follow-up.

RESULTS: PTA was successfully performed in 7 patients without treatment-associated intracerebral hemorrhage. Two patients received distal MCA angioplasty as a secondary intervention: 1 following failed treatment with a Merci retriever and the other after successful removal of proximal clot with a Merci retriever. One patient did not recover from the initial ischemic event despite an excellent angiographic result. Complete recanalization (modified TIMI grade 4) was achieved in 4 patients and near-complete recanalization with mild flow deficit (modified TIMI grade 3), in 3 patients.

CONCLUSIONS: PTA of the distal MCA with a microballoon is safe and effective for acute ischemic stroke. This case series demonstrates that endovascular treatment beyond the MCA bifurcation can dramatically reverse neurologic deficits.

AMC
:   Albany Medical Center
AP
:   anteroposterior
CTA
:   CT angiography
ED
:   emergency department
HH
:   Hunt and Hess
IA
:   intra-arterial
ICA
:   internal carotid artery
Intra
:   drugs delivered between treatments
IV
:   intravenous
L
:   left
MCA
:   middle cerebral artery
mRS
:   modified Rankin Score
NIHSS
:   National Institutes of Health Stroke Scale
Post
:   drugs delivered following mechanical treatment
Pre
:   spasmolytic agents delivered prior to mechanical treatment
PTA
:   percutaneous transluminal angioplasty
R
:   right
RHF
:   right-handed female
rtPA
:   recombinant tissue plasminogen activator
TIMI
:   Thrombolysis in Myocardial Infarction" />
<meta name="og-title" property="og:title" content="The Effectiveness of Microballoon Angioplasty in Treating Middle Cerebral Artery Occlusion Beyond the Bifurcation" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/8/1541" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: PTA effectively treats vasospasm and arterial disease in peripheral, coronary, and large proximal cerebral vessels but rarely reaches small vessels like the distal MCA beyond the bifurcation. Our purpose was to evaluate the safety and efficacy of PTA for distal MCA occlusions in acute ischemic stroke.

MATERIALS AND METHODS: Seven patients had strokes in branches of their MCAs. Following diagnostic angiography, all received microballoon angioplasty and various combinations of IA alteplase (rtPA), abciximab, and/or nitroglycerin. Two also underwent stent placement. Comprehensive retrospective review of the patients' records was performed. Patients' NIHSS scores were reassessed before discharge. Recanalization was evaluated by angiography after treatment and at follow-up.

RESULTS: PTA was successfully performed in 7 patients without treatment-associated intracerebral hemorrhage. Two patients received distal MCA angioplasty as a secondary intervention: 1 following failed treatment with a Merci retriever and the other after successful removal of proximal clot with a Merci retriever. One patient did not recover from the initial ischemic event despite an excellent angiographic result. Complete recanalization (modified TIMI grade 4) was achieved in 4 patients and near-complete recanalization with mild flow deficit (modified TIMI grade 3), in 3 patients.

CONCLUSIONS: PTA of the distal MCA with a microballoon is safe and effective for acute ischemic stroke. This case series demonstrates that endovascular treatment beyond the MCA bifurcation can dramatically reverse neurologic deficits.

AMC
:   Albany Medical Center
AP
:   anteroposterior
CTA
:   CT angiography
ED
:   emergency department
HH
:   Hunt and Hess
IA
:   intra-arterial
ICA
:   internal carotid artery
Intra
:   drugs delivered between treatments
IV
:   intravenous
L
:   left
MCA
:   middle cerebral artery
mRS
:   modified Rankin Score
NIHSS
:   National Institutes of Health Stroke Scale
Post
:   drugs delivered following mechanical treatment
Pre
:   spasmolytic agents delivered prior to mechanical treatment
PTA
:   percutaneous transluminal angioplasty
R
:   right
RHF
:   right-handed female
rtPA
:   recombinant tissue plasminogen activator
TIMI
:   Thrombolysis in Myocardial Infarction" />
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      <h1 class="highwire-cite-title" id="page-title">The Effectiveness of Microballoon Angioplasty in Treating Middle Cerebral Artery Occlusion Beyond the Bifurcation</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">E. Gifford</span>, <span class="highwire-citation-author" data-delta="1">D. Drazin</span>, <span class="highwire-citation-author" data-delta="2">J.C. Dalfino</span>, <span class="highwire-citation-author" data-delta="3">A.K. Nair</span>, <span class="highwire-citation-author" data-delta="4">J. Yamamoto</span> and <span class="highwire-citation-author" data-delta="5">A.S. Boulos</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">September 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1541-1548; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2099 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9792--61270311647" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">E. Gifford </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.%2BGifford%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gifford%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AE.%2BGifford%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">D. 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Nair </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.K.%2BNair%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Nair%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA.K.%2BNair%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">J. Yamamoto </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BYamamoto%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Yamamoto%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.%2BYamamoto%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">A.S. 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<p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> PTA effectively treats vasospasm and arterial disease in peripheral, coronary, and large proximal cerebral vessels but rarely reaches small vessels like the distal MCA beyond the bifurcation. Our purpose was to evaluate the safety and efficacy of PTA for distal MCA occlusions in acute ischemic stroke.</p>
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<p id="p-3"><strong>MATERIALS AND METHODS:</strong> Seven patients had strokes in branches of their MCAs. Following diagnostic angiography, all received microballoon angioplasty and various combinations of IA alteplase (rtPA), abciximab, and/or nitroglycerin. Two also underwent stent placement. Comprehensive retrospective review of the patients' records was performed. Patients' NIHSS scores were reassessed before discharge. Recanalization was evaluated by angiography after treatment and at follow-up.</p>
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<p id="p-4"><strong>RESULTS:</strong> PTA was successfully performed in 7 patients without treatment-associated intracerebral hemorrhage. Two patients received distal MCA angioplasty as a secondary intervention: 1 following failed treatment with a Merci retriever and the other after successful removal of proximal clot with a Merci retriever. One patient did not recover from the initial ischemic event despite an excellent angiographic result. Complete recanalization (modified TIMI grade 4) was achieved in 4 patients and near-complete recanalization with mild flow deficit (modified TIMI grade 3), in 3 patients.</p>
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<p id="p-5"><strong>CONCLUSIONS:</strong> PTA of the distal MCA with a microballoon is safe and effective for acute ischemic stroke. This case series demonstrates that endovascular treatment beyond the MCA bifurcation can dramatically reverse neurologic deficits.</p>
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</div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">AMC<span class="def-item-dt-sep"></span></dt><dd>Albany Medical Center<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">AP<span class="def-item-dt-sep"></span></dt><dd>anteroposterior<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">CTA<span class="def-item-dt-sep"></span></dt><dd>CT angiography<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">ED<span class="def-item-dt-sep"></span></dt><dd>emergency department<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">HH<span class="def-item-dt-sep"></span></dt><dd>Hunt and Hess<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">IA<span class="def-item-dt-sep"></span></dt><dd>intra-arterial<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">ICA<span class="def-item-dt-sep"></span></dt><dd>internal carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">Intra<span class="def-item-dt-sep"></span></dt><dd>drugs delivered between treatments<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">IV<span class="def-item-dt-sep"></span></dt><dd>intravenous<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">L<span class="def-item-dt-sep"></span></dt><dd>left<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">MCA<span class="def-item-dt-sep"></span></dt><dd>middle cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">mRS<span class="def-item-dt-sep"></span></dt><dd>modified Rankin Score<span class="def-item-dd-sep"></span></dd><dt id="def-item-13">NIHSS<span class="def-item-dt-sep"></span></dt><dd>National Institutes of Health Stroke Scale<span class="def-item-dd-sep"></span></dd><dt id="def-item-14">Post<span class="def-item-dt-sep"></span></dt><dd>drugs delivered following mechanical treatment<span class="def-item-dd-sep"></span></dd><dt id="def-item-15">Pre<span class="def-item-dt-sep"></span></dt><dd>spasmolytic agents delivered prior to mechanical treatment<span class="def-item-dd-sep"></span></dd><dt id="def-item-16">PTA<span class="def-item-dt-sep"></span></dt><dd>percutaneous transluminal angioplasty<span class="def-item-dd-sep"></span></dd><dt id="def-item-17">R<span class="def-item-dt-sep"></span></dt><dd>right<span class="def-item-dd-sep"></span></dd><dt id="def-item-18">RHF<span class="def-item-dt-sep"></span></dt><dd>right-handed female<span class="def-item-dd-sep"></span></dd><dt id="def-item-19">rtPA<span class="def-item-dt-sep"></span></dt><dd>recombinant tissue plasminogen activator<span class="def-item-dd-sep"></span></dd><dt id="def-item-20">TIMI<span class="def-item-dt-sep"></span></dt><dd>Thrombolysis in Myocardial Infarction</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/8/1541.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 31</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 8 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Sep 2010 </div></div>
      
      
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      <div class="highwire-cite-title">The Effectiveness of Microballoon Angioplasty in Treating Middle Cerebral Artery Occlusion Beyond the Bifurcation</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Gifford</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Drazin</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">J.C.</span> <span class="nlm-surname">Dalfino</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">A.K.</span> <span class="nlm-surname">Nair</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Yamamoto</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">A.S.</span> <span class="nlm-surname">Boulos</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Sep 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1541-1548; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2099 </span></div>
  
  
  
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      <div class="highwire-cite-title">The Effectiveness of Microballoon Angioplasty in Treating Middle Cerebral Artery Occlusion Beyond the Bifurcation</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Gifford</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Drazin</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">J.C.</span> <span class="nlm-surname">Dalfino</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">A.K.</span> <span class="nlm-surname">Nair</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Yamamoto</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">A.S.</span> <span class="nlm-surname">Boulos</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Sep 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1541-1548; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2099 </span></div>
  
  
  
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