Hypoperfusion Infarctions of Unexpected Territories after Angioplasty of Intracranial Stenoses

Abstract

ischemic stroke and accounts for 8% to 15% of strokes caused by cerebral atherosclerosis, depending on the population studied (1, 2). Sometimes patients with symptomatic intracranial atherosclerotic stenosis are insufficiently protected against ischemic stroke despite medication with platelet aggregation inhibitors. However, the treatment of patients with intracranial atherosclerosis lesions remains controversial. The results of endovascular revascularization of intracranial vessels with balloonor stent-assisted angioplasty or stent have been tempered by the increased risk of stroke (3). The availability of recently introduced flexible stents, the development of potent platelet aggregation inhibitors, and increasing evidence from experimental and clinical studies of intracranial stents have improved the endovascular management of ischemic intracranial cerebrovascular disease. Complications from intracranial artery angioplasty and stenting (IAS) include cerebral infarction, intracranial hemorrhage caused by reperfusion injury, and contrast-induced renal failure. Most cerebral infarctions are directly related to the endovascular procedure, involving the ipsilateral vascular territory (4). This ischemic complication results from distal embolization, vessel dissection, and acute vessel occlusion secondary to dissection or platelet aggregation. We present two cases with unexpected infarctions involving territories unrelated to IAS procedures.