Figure 6.

Placement of a balloon-mounted stent (BMS) for large vessel diameter and short length of the culprit stenosis. An acute middle cerebral artery (MCA) occlusion occurred in a 79-year-old female with history of previous stroke due to stenosis in M1 segment of left MCA (baseline modified Rankin Scale 1) currently treated with aspirin monotherapy presenting to an outside hospital with fluctuating severe aphasia and right hemiparesis. After telemedicine consultation, she was loaded with ticagrelor 180 mg prior to transfer. Upon arrival, National Institutes of Health Stroke Scale was 13 and time from last known normal was greater than 12 hours. Multimodal computed tomography (CT) showed left MCA-M1 occlusion with Alberta Stroke Program Early CT Score 9 and a large perfusion mismatch. The patient was brought to angiography suite for endovascular reperfusion treatment. (A) Initial angiogram showed complete left M1 occlusion. (B) Standard thrombectomy was performed with a Trevo XP (4×30 mm) stent-retriever. (C) After one device pass, a focal severe stenosis was found. The atherosclerotic lesion was short, and both diameters of stent landing zones were similar and over 2 mm, so a BMS was chosen for intracranial stenting. (D) The mounted balloon is inflated for deployment. (E) The Integrity stent (2.25×9 mm) is deployed with good wall apposition. (F) Final angiography shows complete recanalization and reperfusion. The patient recovered to her baseline.