Abstract
RATIONALE: Intraoperative hemorrhage and acute vascular occlusion during middle cerebral artery (MCA) balloon angioplasty constitute critical complications. The cooccurrence of these complications is rare and, if improperly managed, can lead to severe sequelae or become life-threatening. PATIENT CONCERNS: A 64-year-old female patient presented with MCA stenosis. Imaging studies indicated watershed infarction in the corresponding blood supply area, along with vulnerable plaque and severe stenosis in the M1 segment of the right MCA. DIAGNOSES: Severe stenosis (>70%) of the right MCA with associated (watershed) cerebral infarction. INTERVENTIONS: Following balloon angioplasty of the MCA, vascular rupture with hemorrhage occurred; immediate balloon occlusion achieved hemostasis. Subsequently, subtotal occlusion secondary to acute thrombus formation developed. The operator implanted a self-expanding stent with a planar coiled structure. This intervention successfully recanalized the occluded vessel without causing recurrent hemorrhage. OUTCOMES: Stent deployment successfully revascularized the right MCA stenosis, with intraoperative hemorrhage controlled and acute thrombotic occlusion resolved. The patient recovered without neurological deficits, achieving a modified Rankin Scale score of 0 at discharge. LESSONS: In the course of balloon angioplasty for MCA stenosis, the occlusion of acute hemorrhage can be achieved through balloon dilation compression. Following the establishment of hemostasis, the treatment of acute vascular occlusion can be facilitated by the implantation of a "planar coiled structure" self-expanding stent, thereby successfully achieving recanalization of the MCA without inducing local vascular rehemorrhage.