• Jun Liu, Wenpeng Lu, Hao Han, Lijian Zheng, Lei Feng, and Weimei Chen.
• Department of Neurosurgery, The First People's Hospital of Jining, Jining, Shandong, China.
• World Neurosurg. 2019 Feb 1; 122: 665-670.

BackgroundStenosis of the target intracranial vertebral artery is one of the major causes of posterior circulation ischemic stroke. The objective of this paper is to explore methods for reducing the occurrence of medullary artery occlusion after intracranial vertebral artery stenting.Case DescriptionThe current research presents a retrospective analysis of 48 patients who received Gateway-Wingspan stent angioplasty to treat severe stenosis of the intracranial vertebral artery, evaluates the results of stenosis remission and perfusion improvement after stent angioplasty, and explores the causes of postoperative medullary artery occlusion. A total of 49 Wingspan stents were implanted in the 48 patients, with a surgical success rate of 100%. After stent implantation, the patients' rates of intracranial vertebral artery stenosis dropped from 75.9% ± 6.3% to 28.4% ± 5.1%. Transcranial Doppler or cranial computed tomography angiography 3 months after surgery showed that none of the patients suffered from in-stent restenosis. Within 24 hours after surgery, medullary perforating artery occlusion occurred in 2 patients, probably because atherosclerotic plaque in the stenotic area became less stable and displaced under the mechanical action of postoperative saccule and stent. As a result, the medullary artery was blocked. After drug and rehabilitation therapies, the patients' symptoms were alleviated.ConclusionsPerforating artery occlusion after intracranial vertebral artery stenting can be prevented by strict assessment and preparation before surgery, correct choices of saccule and stent during operation, and other measures. However, large sample data are needed for verification.Copyright © 2018 Elsevier Inc. All rights reserved.

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