Endovascular stenting to treat an acute stroke caused by severe stenosis of the duplicated middle cerebral artery

BACKGROUND: The duplicated middle cerebral artery (DMCA), a rare anatomical variant of the middle cerebral artery, arises between the anterior choroidal artery and the distal end of the internal carotid artery. We present the case of a patient who had an acute progressive stroke caused by severe stenosis in the initial segment of the DMCA and was successfully treated with endovascular stenting. CASE PRESENTATION: A 57-year-old man was admitted to our hospital with sudden left extremity weakness for three days. Cranial magnetic resonance imaging revealed multiple fresh infarcts in the right basal ganglia and temporal lobe. Cerebrovascular imaging revealed severe stenosis of the right DMCA’s initial segment. However, despite standard medical therapy, the patient’s limb weakness worsened. Based on the clinical and imaging findings, we speculated that severely stenotic DMCA is responsible for the acute progressive stroke. On the basis of the best medical treatment, the patient successfully underwent endovascular stent implantation under general anesthesia two weeks after the onset. The patient’s condition was stable after interventional therapy, and his postoperative follow-up prognosis was favorable. CONCLUSIONS: Endovascular stenting may be a feasible treatment for symptomatic severe stenosis of the DMCA in cases of poor control with standard medications.