Journal of neuroendovascular therapy · 2026
A Case of Successful Stent Retriever Angioplasty Using the Tigertriever for Acute M1 Segment Occlusion of the Middle Cerebral Artery due to Atherosclerotic Disease.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Akiyama Ryo, Sawamura Sou, Yamada Daisuke, Tsujino Kohei, Matsukawa Hidetoshi, Shimizu Fuminori, Akiyama Yoshinori, Yoshida Takashi, Sakai Nobuyuki
Аннотация
OBJECTIVE: The optimal treatment strategy for acute ischemic stroke due to intracranial atherosclerotic disease (ICAD-AIS) has not been established. The Tigertriever (Rapid Medical, Yokneam, Israel) is a unique stent retriever (SR) that allows manual adjustment of radial expansion force, a feature that may be advantageous for the treatment of ICAD-AIS. We report a case of ICAD-AIS successfully treated with SR angioplasty using the Tigertriever.
CASE PRESENTATION: A 71-year-old man developed sudden-onset left hemiplegia and was transported to our hospital 38 min after symptom onset. The National Institutes of Health Stroke Scale score was 13. MRA demonstrated occlusion of the right M1 segment of the middle cerebral artery (MCA), and diffusion-weighted imaging (DWI) showed faint hyperintensity in the posterior corona radiata. DSA revealed occlusion of the distal right M1 segment with good leptomeningeal collateral flow to the MCA territory. Given the patient's multiple atherosclerotic risk factors, the occlusion was clinically suspected to be associated with ICAD. After administration of aspirin (200 mg) and prasugrel (20 mg), SR angioplasty was performed using a Tigertriever 17. Postprocedural DSA demonstrated residual stenosis of approximately 50%; however, no recoil or re-occlusion was observed. The puncture-to-recanalization time was 23 min. Postprocedural DWI showed only a small hyperintense lesion in the right putamen, with no evidence of re-occlusion. The patient was discharged home on day 11 with a modified Rankin Scale (mRS) of 0. The post-procedure antiplatelet regimen was aspirin (100 mg) plus prasugrel (3.75 mg) for 1 month, followed by aspirin (100 mg) plus cilostazol (200 mg) until 6 months, and aspirin (100 mg) alone thereafter. During the 9-month follow-up, the mRS remained 0 without re-occlusion of the stenotic lesion.
CONCLUSION: The Tigertriever may enable effective angioplasty for intracranial atherosclerotic stenotic lesions by allowing controlled adjustment of radial expansion force. This device may represent a promising therapeutic option for the treatment of ICAD-AIS.
CASE PRESENTATION: A 71-year-old man developed sudden-onset left hemiplegia and was transported to our hospital 38 min after symptom onset. The National Institutes of Health Stroke Scale score was 13. MRA demonstrated occlusion of the right M1 segment of the middle cerebral artery (MCA), and diffusion-weighted imaging (DWI) showed faint hyperintensity in the posterior corona radiata. DSA revealed occlusion of the distal right M1 segment with good leptomeningeal collateral flow to the MCA territory. Given the patient's multiple atherosclerotic risk factors, the occlusion was clinically suspected to be associated with ICAD. After administration of aspirin (200 mg) and prasugrel (20 mg), SR angioplasty was performed using a Tigertriever 17. Postprocedural DSA demonstrated residual stenosis of approximately 50%; however, no recoil or re-occlusion was observed. The puncture-to-recanalization time was 23 min. Postprocedural DWI showed only a small hyperintense lesion in the right putamen, with no evidence of re-occlusion. The patient was discharged home on day 11 with a modified Rankin Scale (mRS) of 0. The post-procedure antiplatelet regimen was aspirin (100 mg) plus prasugrel (3.75 mg) for 1 month, followed by aspirin (100 mg) plus cilostazol (200 mg) until 6 months, and aspirin (100 mg) alone thereafter. During the 9-month follow-up, the mRS remained 0 without re-occlusion of the stenotic lesion.
CONCLUSION: The Tigertriever may enable effective angioplasty for intracranial atherosclerotic stenotic lesions by allowing controlled adjustment of radial expansion force. This device may represent a promising therapeutic option for the treatment of ICAD-AIS.