Atherosclerotic Left Middle Cerebral Artery Occlusion, Treated 72 Hours After Symptoms Onset with a Balloon-Mounted Stent and Good Clinical Outcome

Non-acute intracranial occlusion (NAICO) is defined as an angiographic complete atherosclerotic occlusion of an intracranial artery, with ischemic symptoms duration longer than 24 h from the time last seen well. In patients with large vessel occlusion (LVO) due to pre-existing and slowly progressive artery stenosis, the collateral development and the stroke evolution tend to be slower than in patients with more abrupt stroke etiologies. Patients treated more than 24 h after definite symptom recognition more often have large vessel atherosclerotic stenosis or occlusion. Balloon dilatation of an underlying stenosis with or without stenting is an accepted treatment strategy and allows clinical recovery well beyond any “time window.” We describe a representative case of NAICO in a 65-year-old patient with an atherosclerotic occlusion of the left middle cerebral artery (MCA) treated 72 h after the onset of stroke symptoms. Reperfusion of the MCA with two balloon expandable coronary stents allowed for a significant improvement in the patient’s clinical condition. The delayed reperfusion of NAICO is the main topic of this chapter.