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Intracranial atherosclerosis accounts for 5–15% of ischemic strokes, depending on the population studied. Patients with recently symptomatic intracranial stenosis have high rates of stroke with medical therapy. In the Warfarin Aspirin Symptomatic Intracranial Disease (WASID) study, the rate of stroke was approximately 10% per year.1
The limitations of medical therapy coupled with technological advances have prompted consideration of intracranial stenting as treatment for intracranial stenoses in selected patients. A major concern of intracranial angioplasty with or without stent placement has been occlusion of the perforating vessels such as the lenticulostriate arteries during middle cerebral artery angioplasty.
In this issue of Neurology, Jiang et al.2 report a large, single-center experience of intracranial stenting for symptomatic atherosclerotic disease. In this series, 181 lesions were treated with balloon-expandable stents. Perforator strokes occurred in only 3.0% of patients. Patients with preprocedural infarction of territories fed by perforators had postprocedural infarction (or transient worsening) at a rate significantly higher than patients without pretreatment perforator-region infarctions (8.2% vs 0.8%). These figures may …
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