醫學研究

Perforator stroke after elective stenting of symptomatic intracranial stenosis.

Leung TW, Mak H, Yu SC, Wong KS.  Neurology. 2007 Apr 10;68(15):1237; author reply 1237. doi: 10.1212/01.wnl.0000261903.62909.0d. PMID: 17420415.

To the Editor:

Branch vessel occlusion by snow plowing effect and jailing has been a concern in intracranial stenting. Jiang et al.1 reported a low rate of perforator stroke (3.0%) by coronary balloon-mounted stents. However, the figure could be an underestimate as CT rather than MRI was used for diagnosis. The editorial 2 in the same issue described the current trend of using self-expanding stent (Wingspan) in intracranial vasculature. The system allows submaximal balloon dilatation, which may reduce the risk of acute perforator occlusion. It is unclear whether the subsequent luminal gain of the parent artery through the sustained radial force of the self-expanding stent will lead to subacute jailing or occlusion of the perforators.

In our center, paired MRI (pre- and post-stenting) was obtained to look for new infarcts in the perforator zone of the treated artery in patients who had angioplasty by Wingspan system. The post-stenting MRI was performed 4 months after the procedure. Among the six patients who had stenting at the perforator-rich arteries (M1 middle cerebral artery or basilar artery), none had clinical stroke or new infarcts evident on T2-weighted images in the immediate perforator zone.

Citation:

https://pubmed.ncbi.nlm.nih.gov/17420415/