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
![](http://www.neuroangio.org/wp-content/uploads/Archives/Stroke/Re-occlusion-stented-M2-onyx-restenting/Re-occlusion-M2-Onyx-stent-restenting-with-patency-00.png)
![](http://www.neuroangio.org/wp-content/uploads/Archives/Stroke/Re-occlusion-stented-M2-onyx-restenting/Re-occlusion-M2-Onyx-stent-restenting-with-patency-01.png)
![](http://www.neuroangio.org/wp-content/uploads/Archives/Stroke/Re-occlusion-stented-M2-onyx-restenting/Re-occlusion-M2-Onyx-stent-restenting-with-patency-02.png)
Fairly easily crossed with SL-10
![](http://www.neuroangio.org/wp-content/uploads/Archives/Stroke/Re-occlusion-stented-M2-onyx-restenting/Re-occlusion-M2-Onyx-stent-restenting-with-patency-03.png)
A stent-in-stent Onyx Frontier 2×8 — placed telescopically into the pre-existing Onyx Resolute
![](http://www.neuroangio.org/wp-content/uploads/Archives/Stroke/Re-occlusion-stented-M2-onyx-restenting/Re-occlusion-M2-Onyx-stent-restenting-with-patency-05.png)
Despite stenting, there is still narrowing of the proximal M2
![](http://www.neuroangio.org/wp-content/uploads/Archives/Stroke/Re-occlusion-stented-M2-onyx-restenting/Re-occlusion-M2-Onyx-stent-restenting-with-patency-06.png)
![](http://www.neuroangio.org/wp-content/uploads/Archives/Stroke/Re-occlusion-stented-M2-onyx-restenting/Re-occlusion-M2-Onyx-stent-restenting-with-patency-07.png)
![](http://www.neuroangio.org/wp-content/uploads/Archives/Stroke/Re-occlusion-stented-M2-onyx-restenting/Re-occlusion-M2-Onyx-stent-restenting-with-patency-08.png)
![](http://www.neuroangio.org/wp-content/uploads/Archives/Stroke/Re-occlusion-stented-M2-onyx-restenting/Re-occlusion-M2-Onyx-stent-restenting-with-patency-09.png)
![](http://www.neuroangio.org/wp-content/uploads/Archives/Stroke/Re-occlusion-stented-M2-onyx-restenting/Re-occlusion-M2-Onyx-stent-restenting-with-patency-10.png)
![](http://www.neuroangio.org/wp-content/uploads/Archives/Stroke/Re-occlusion-stented-M2-onyx-restenting/Re-occlusion-M2-Onyx-stent-restenting-with-patency-11.png)
So this time we did an angio 6 weeks after stenting — widely patent.
![](http://www.neuroangio.org/wp-content/uploads/Archives/Stroke/Re-occlusion-stented-M2-onyx-restenting/Re-occlusion-M2-Onyx-stent-restenting-with-patency-12.png)
Plan is to maintain on dual antiplatelets for 1 year at least