Technical Nuance of Sub 2-mm Middle Cerebral Artery Angioplasty and Stenting.

Intracranial stenosis is among the common causes of ischemic strokes, especially in the Asian, African, and Hispanic populations. The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial showed that, by 30 days, 33 (14.7%) of 224 patients in the stenting group and 13 (5.8%) of 227 patients in the medical group had died or had a stroke. The WEAVE (Wingspan Stent System Post Market Surveillance) trial showed 2%-2.7% periprocedural complications. However, with technical advancements and more experience, angioplasty and stenting in high-risk cases are feasible and successful even in vessels <2 mm. We present the technical nuances of angioplasty and stenting of a sub-2-mm intracranial vessel by submaximal balloon inflation. Both patients had recurrent ischemic stroke symptoms on best medical management. Best medical management includes a dual antiplatelet regimen with a high-dose statin. Both patients were compliant and had therapeutic platelet reactive unit.