Successful Rescue Treatment for Acute Ischemic Stroke Due to Intracranial Atherosclerotic Disease Using the Neuroform Atlas Stent

The recanalization rate of endovascular therapy for acute ischemic stroke in intracranial atherosclerotic disease (ICAD) is inferior to that of cardiogenic stroke. This case study presents the long-term outcomes of a patient who underwent implantation of the Neuroform Atlas stent for the treatment of intracranial carotid artery stenosis, despite repeated re-occlusions after percutaneous transluminal angioplasty (PTA). A 75-year-old woman was transferred to our hospital with aphasia. Diffusion-weighted imaging revealed the absence of recent infarction. Magnetic resonance angiography indicated an occlusion of the left internal carotid artery (ICA). Diagnostic cerebral angiography revealed severe stenosis of the left ICA, accompanied by a markedly delayed blood flow to the left middle cerebral artery region. Therefore, we decided to proceed with endovascular surgery. The guide catheter was advanced into the ICA which was spontaneously recanalized. The patient again exhibited symptoms of aphasia the next day. We decided to perform PTA, but restenosis was observed immediately. The Neuroform Atlas was placed within the stenosis. Following this, the ICA was confirmed to be open. At the one-year follow-up, cerebral angiography demonstrated optimal patency of the left ICA. The Neuroform Atlas demonstrated favorable angiographic patency over one year when implanted as a rescue stent in revascularization procedures for ICAD. Hence, its use for rescue purposes in acute settings may be considered a treatment option.