Angioplasty and stenting of symptomatic intracranial atherosclerotic stenosis: a dual-center experience using NeuroSpeed balloon-catheter and CREDO heal stent

Abstract Background Intracranial atherosclerotic stenosis (ICAS) remains a significant cause of recurrent ischemic strokes. While aggressive medical management is the mainstay of treatment, percutaneous transluminal angioplasty (PTA) and intracranial stenting (ICS) are increasingly used, especially in cases refractory to medical therapy or as a bailout during frustrating thrombectomy. Objective To evaluate the safety, technical feasibility, and short-term outcomes of NeuroSpeed balloon-catheter angioplasty and CREDO heal stent implantation in patients with symptomatic ICAS with and without large or medium vessel occlusion (LVO/MeVO). Methods This retrospective, dual-center study included 42 patients who underwent ICS using the NeuroSpeed balloon-catheter and fibrin-heparin coated CREDO heal stent. Patients were divided into two subgroups: ICAS ( n = 23) and Bailout stenting ( n = 19). Procedural success with a stenosis grade reduction to ≤ 50%, complication rates, and clinical outcomes were analyzed. Results Technical success was achieved in 83% of cases. Clinical improvement was significant between baseline and follow-up, with a reduction in the median modified Rankin Scale score from 2 to 0 ( p = 0.005). Acute stent occlusion occurred in 2 of 19 patients (10.5%) in the bailout group. Late vascular follow-up imaging was available in 30 patients; two asymptomatic delayed stent occlusions occurred in the ICAS group (2/23, 8.7%) and two cases of in-stent restenosis in the bailout group (2/19, 10.5%). Procedure-related intracranial hemorrhage occurred in one patient in the ICAS group (1/23, 4.3%) and one patient in the bailout group (1/19, 5.3%). One access-site pseudoaneurysm (1/42, 2.4%) was observed. Conclusion NeuroSpeed/CREDO-based intracranial stenting appears to be a technically feasible treatment for high-grade ICAS and as a bailout during thrombectomy, with favorable short-term clinical outcomes and acceptable complication rates. Further prospective studies are warranted to assess long-term safety, efficacy, and durability.