Some more advanced intracranial stenting management. As elsewhere in the body, the main problem with atherosclerotic disease stenting is re-stenosis/re-occlusion. This is often addressed by re-stenting outside the brain. It can also be done inside.

Patient presented with left MCA syndrome 5 weeks before. Found to have M2 segment atheromatous occlusion. Treated with stenting. See case here.

Five weeks later re-presents with MCA symptoms. Imaging shows re-occlusion. Perfusion below

Fairly easily crossed with SL-10

A stent-in-stent Onyx Frontier 2×8 — placed telescopically into the pre-existing Onyx Resolute

Despite stenting, there is still narrowing of the proximal M2

So this time we did an angio 6 weeks after stenting — widely patent.

Plan is to maintain on dual antiplatelets for 1 year at least

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