case_images: PMC2909725_01
case_images: (a) Contrast-enhanced cranial CT with discontinuation of left MCA. (b) CT perfusion test revealed increased time to peak in the velocity.
case_images: CRM2010-138023.001.jpg
case_images: PMC2909725_01_CRM2010-138023.001.jpg
case_images: fig1
case_images: Sign:HMCAS) and CT perfusion test revealed increased time to peak in the velocity (Figure 1(b)). Since the i.v. thrombolysis failed, urgent digital subtraction angiography (DSA) was performed (Figure 2(a)). 
case_images: (a) Diagnostic angiogram (left internal carotid artery injection, anteroposterior projection) shows (arrow) the occlusion of the horizontal segment of the left middle cerebral artery (MCA). (b) Coaxial catheterization with a microcatheter and stirable microguidewire entering the occluded vessel, traversed the occluded segment of the left MCA. With the contrast, the peripheral MCA is visualized.
case_images: CRM2010-138023.002.jpg
case_images: PMC2909725_01_CRM2010-138023.002.jpg
case_images: fig2
case_images: Sign:HMCAS) and CT perfusion test revealed increased time to peak in the velocity (Figure 1(b)). Since the i.v. thrombolysis failed, urgent digital subtraction angiography (DSA) was performed (Figure 2(a)).  Then followed coaxial catheterization with a microcatheter and stirable microguidewire entering the occluded left MCA and then the microcatheter was positioned with its tip just distal to the occlusion, which was proven with the injection of the contrast media, and the "normal" arterial outline was visualized peripheral to the embolus. (Figure 2(b)).
case_images: Vascular retrieval snare in the distal part of microcatheter. The snare (arrow) has been deployed out of the microcatheter just enough to open fully, and retrieved back in the microcatheter.
case_images: CRM2010-138023.003.jpg
case_images: PMC2909725_01_CRM2010-138023.003.jpg
case_images: fig3
case_images: Angiogram before and after deployment of the intraarterial Neuroform Stent 3 x 20 mm (arrows).
case_images: CRM2010-138023.004.jpg
case_images: PMC2909725_01_CRM2010-138023.004.jpg
case_images: fig4
case_images: An intracranial stent (Boston Scientific, Neuroform 3) 3 x 20 mm (Figure 4(a)) was placed in the horizontal MCA with sufficient restoration of flow (Figure 4(b)). 
case_images: Follow-up angiogram immediately after re-opening of the left MCA (left ICA injection), anteroposterior (a) and lateral (b) views show a patent, though slightly narrower left MCA (arrows).
case_images: CRM2010-138023.005.jpg
case_images: PMC2909725_01_CRM2010-138023.005.jpg
case_images: fig5
case_images: Control CT scan shows a small haematoma in the left hemisphere.
case_images: CRM2010-138023.006.jpg
case_images: PMC2909725_01_CRM2010-138023.006.jpg
case_images: fig6
case_images: Follow-up angiograms:antero-posterior (a) and lateral views (b) 6 months later. The stented segment of MCA is indicated with arrows.
case_images: CRM2010-138023.007.jpg
case_images: PMC2909725_01_CRM2010-138023.007.jpg
case_images: fig7
case_images: Six months after treatment: thrombolytic therapy and stenting of the left MCA angiogram shows good patency of the stented artery (Figures 7(a) and 7(b)).