Value of imaging lenticulostriate arteries before middle cerebral artery stenting for the prevention of perforator stroke

In this study, we investigated whether pre-procedural imaging of LSAs would potentially be helpful for preventing LSAs from being covered.We retrospectively evaluated the LSAs of 15 consecutive patients who underwent revascularization for symptomatic middle cerebral artery (MCA) stenosis. All patients underwent two- (2D) and three-dimensional (3D) digital subtraction angiography.We found that 46.7 (7/15), 40 (6/15), and 13.3 % (2/15) of patients had stenotic lesions in the proximal, middle, and distal third of the M1 segment, respectively. There was a total of 32 LSAs that originated from the lesioned MCAs. Seven (21.9 %), 10 (31.3 %), 11 (34.4 %), and 4 (12.5 %) LSAs originated from the proximal third of the M1 segment, middle third of the M1 segment, distal third of the M1 segment, and starting segment of the superior M2 segment, respectively. Sixteen (76.2 %) of 22 LSAs in 13 patients were covered by stents. It would have been possible to avoid covering 43.8 % (7/16) of these LSAs with stents if they had been evaluated before stenting, and the stents had been accurately deployed. Among 16 LSAs which were covered by stent, only one (6.25 %) was occluded after coverage.Our data suggest that evaluation of LSAs during MCA stenting would be potentially helpful for preventing LSAs from being covered and subsequently occluded by stents.