PMC2909725_01
(a) Contrast-enhanced cranial CT with discontinuation of left MCA. (b) CT perfusion test revealed increased time to peak in the velocity.
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fig1
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)). 
(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.
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fig2
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)).
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.
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fig3
Angiogram before and after deployment of the intraarterial Neuroform Stent 3 x 20 mm (arrows).
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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)). 
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).
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fig5
Control CT scan shows a small haematoma in the left hemisphere.
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Follow-up angiograms:antero-posterior (a) and lateral views (b) 6 months later. The stented segment of MCA is indicated with arrows.
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fig7
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)).