Would Self-Expanding Stent Occlude Middle Cerebral Artery Perforators?

Background and Purpose-A major concern of intracranial stenting is perforator infarction. It is unclear whether the sustained radial force of a self-expanding stent or subsequent stent restenosis would cause late occlusion of perforators. Methods-We compared the baseline and poststent (>= 4 months) MRI scans of patients who underwent self-expanding stenting for recurrent ischemic symptoms attributed to a MCA stenosis >= 60%. New infarcts in the ipsilateral striatocapsular region were recorded. Results-MCA stenting was technically successful in 23 of 24 recruited patients. No new perforator territory infarct was found in follow-up MRI scans of all recruited patients. Postoperatively, all patients reported no further TIA or stroke over a median follow-up of 15 months. Conclusions-The use of a self-expanding stent in patients with high-grade MCA stenosis may not pose a major risk to the perforators. (Stroke. 2009; 40: 1910-1912.)