20 Endovascular Therapy for Patients with an Isolated M2 Occlusion
20.1 Case Description
20.1.1 Clinical Presentation
A 64-year-old female with a past medical history significant for hypertension and idiopathic thrombocytopenic purpura presented to the emergency department (ED) of a thrombectomy capable hospital with global aphasia. National Institutes Health Stroke Scale (NIHSS) score was 4. The patient did not have a definitive last time known well and as such was not eligible for intravenous (IV) thrombolysis.
20.1.2 Imaging Workup and Investigations
Noncontrast computed tomography (NCCT) performed in the ED demonstrated early left insular changes; her ASPECTS score was 9 (Fig. 20.1).
CT angiogram (CTA) demonstrated an occlusion of the left middle cerebral artery (MCA)’s proximal inferior division (M2; Fig. 20.2).
Fig. 20.1 NCCT demonstrating early changes in the left insular cortex. 
Fig. 20.2 Coronal CTA MIPS showing a left inferior division M2 occlusion.
20.1.3 Diagnosis
Left M2 inferior division occlusion with minimal changes on NCCT.
20.1.4 Management
The patient had no definitive last time known well. As such, the patient was not eligible for IV thrombolysis.
The patient was taken to the catheterization laboratory for urgent neurointervention.
20.1.5 Endovascular Treatment
Materials
6-Fr short vascular access sheath.
Davis 5 Fr diagnostic catheter.
90-cm Neuron Max 88 guide catheter.
Terumo guidewire.
Rosen exchange length wire.
Penumbra ACE 60 reperfusion catheter.
3 Max reperfusion catheter.
Velocity microcatheter.
Sychro-2 soft microwire.
Solitaire 4 mm × 40 mm stent retriever.
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