CASE REPORT Navigability Trumps All: Stenting of Acute Middle Cerebral Artery Occlusions with a New Self- Expandable Stent

SUMMARY: Acute stroke intervention is rapidly evolving. New technologies are improving device deliverability and rates of recanalization. We describe 2 cases of acute middle cerebral artery occlu-sions wherein Wingspan stents could not be delivered to the occlusive site because of excessive vascular tortuosity. Merci thrombectomy was also unsuccessful. Revascularization was only achieved with deployment of the highly navigable Enterprise stent, resulting in thrombolysis in myocardial infarction 2/3 flow. Thus, all devices should be considered in the armamentarium of stroke therapy. Intra-arterial therapies for acute stroke have evolved rapidlyin recent years.1,2 Although the newer-generationMercime-chanical clot retriever (Concentric Medical, Mountain View, Calif) achieved successful recanalization in 70 % of patients,2 this was only marginally superior to the 66 % recanalization rate in the Prolyse in Acute Cerebral Thromboembolism II trial.1 Although encouraging, substantial room for improve-ment exists. Coronary (balloon-expandable) stents have been used suc-cessfully in acute stroke intervention with published recanali-zation rates of 79%.3Use of a balloon- or self-expandable stent has been found to be an independent predictor of successful recanalization (OR, 4.8).4 Modern balloon-expandable stents have become increasingly trackable and flexible; however, comparedwith self-expandable stents specifically designed for the intracranial circulation, balloon-expandable stents are larger and stiffer.5 On the basis of early, encouraging results of acute intra-cranial revascularization with stents and knowledge that self-expandable stents are more trackable and have lowe