Fig. 1.

Two patients with SMR-ICAS treated with different stents: Wingspan for the left cavernous to petrous ICA (A-D) vs Credo for the right MCA M1 segment (E-H). The presenting angiographies showed significant (>70%) stenosis (A, E). In the Wingspan stent system, following guidewire exchange to a 300-cm wire, angiography was performed with a Gateway PTA balloon catheter (B). Subsequently, the balloon was removed and replaced with the Wingspan stent, which was then deployed along the wire (C; the dotted arrows show the stent markers; the solid arrows show the stent catheter tip). For Credo stenting, angioplasty was performed with a NeuroSpeed PTA balloon catheter (F), followed by guidewire retrieval and stent advancement within the balloon catheter without direct contact with the atherosclerotic plaque. Stenting was performed with the unsheathed technique (G; the dotted arrows show the stent markers, and the solid arrows show the balloon catheter markers). Follow-up CT angiography by curved multiplanar reconstruction showing the patent vessels and stents (D, H; white arrows indicate the distal and proximal markers). CT = computed tomography; PTA = percutaneous transluminal angioplasty; SMR-ICAS = severe medically refractory intracranial artery stenosis.