Patency of the lenticulostriate and Pontine arteries after stenting of the intracranial arteries

Interventional neuroradiology methods have a well-established role in the treatment of many cerebrovascular diseases, including ischemic and hemorrhagic stroke, with perforating artery strokes being a complication that limits recovery after intracranial artery stenting. The aim of this study was to investigate the influence of covering the perforating artery origins with stent struts on their patency.Two geometric models of coverage of the perforating artery ostia by stent struts were developed, and calculations were made using data on origin dimensions from a collection of 3D models of twenty-three middle cerebral arteries and ten basilar arteries obtained by scanning a collection of anatomical specimens via microcomputed tomography.Analysis of 323 perforating artery geometries revealed that flow-diverting stents reduced the area of perforator origin from a few to 20-30%, whereas in the case of conventional stents, at least one third of the origin in every second perforator studied was covered. Smaller perforating arteries may be completely closed by the stent struts. In the case of implantation of two stents using telescopic technique, the coverage percentages were approximately 2 times higher.Stenting may significantly reduce the effective cross-sectional area of the perforating artery origin. The influence depends on the type of stent: flow diverting stents exert a mesh-effect, and the effect of classic stents is related to strut width. The effect is exacerbated by the implantation of two stents. Considering the supply areas of the pontine and lenticulostriate arteries, even small perforating artery infarction may lead to devastating neurological complications. To increase the safety of intracranial artery stenting, it is reasonable to design and use stents with the narrowest possible struts.