Tandem Short-length Multi-stent Construct for Emergent Revascularization of Occlusive Long-segment Left Middle Cerebral Artery In-stent Stenosis

Endovascular stenting and balloon angioplasty is a feasible although controversial option for intracranial atherosclerotic stenosis refractory to maximize medical management. High rates of symptomatic in-stent restenosis (ISR) have been identified with Wingspan stent (Stryker, Fremont, CA, USA) placement. Revascularization of ISR by way of re-stenting is often attempted, albeit with high risk and low durability. In lesions with long-segment non-focal critical or emergent occluded stenosis, re-stenting with a single balloon mounted stent is not possible due to deliverability of a lengthy device through a tortuous carotid siphon. Tandem drug-eluting stent placement within the middle cerebral artery to address acute, occlusive ISR using a Wingspan stent, with additional stent reconstruction, has not been previously described.