Emergency Angioplasty and Stenting for a Symptomatic High-Grade Intracranial Stenosis

A 73-year-old male patient with a medical history of metabolic syndrome was admitted to our hospital because of a transient ischemic attack, which entirely resolved shortly after that. Diagnostic imaging indicated severe stenosis of the left middle cerebral artery. His clinical condition later deteriorated on the same day despite maximal conservative treatment. Additional non-invasive and invasive diagnostic workups indicated minor ischemic changes in the left deep white matter and severe hypoperfusion of the MCA supply territory distal to the stenosis. We performed an emergency balloon angioplasty and stenting as a salvage procedure the same night. The patient markedly improved afterwards and was discharged with an NIHSS score of 1 on day 8 after the intervention. Interventional therapy for intracranial stenoses remains controversial despite this procedure’s enormous technical improvement and increased safety margins. The case described herein shows an optimal clinical outcome in a patient with a high-grade hemodynamically relevant intracranial stenosis treated endovascularly.