Figure 4

Endovascular recanalization of occluded left middle cerebral artery (MCA) and angiographic follow-up. (A) DWI of magnetic resonance imaging (MRI) immediately after admission revealed bead-like high signal in the left hemisphere. (B) Computed tomography angiography showed occluded M1 segment of the left MCA. (C) Two days after admission, DWI of MRI demonstrated increased area of high signal lesions in the left hemisphere with fusion of the original bead-like lesions. (D) PWI of MRI revealed greater time needed for the blood flow to reach the left hemisphere. (E) Digital subtraction angiography showed occluded M1 segment of the left MCA with no display of the distal arterial branches. (F) A microguidewire was used to explored the occluded M1 segment, and a microcatheter was navigated along the microguidewire through the occluded M1 segment into the M2 segment of the left MCA, and angiography through this microcatheter indicated patency of distal arterial branches. (G) An Enterprise 4.5 mm*22 mm stent was deployed at the occluded segment after balloon angioplasty, with recanalized arterial branches of the left MCA. (H) PWI of MRI demonstrated improved blood flow to the left hemisphere, much better than before recanalization. (I) Digital subtraction angiography six months later revealed patent left MCA with no instent stenosis.