Exchange-free single-pass gateway balloon–assisted neuroform atlas stenting for symptomatic high-grade intracranial atherosclerotic stenosis: clinical and angiographic outcomes
Abstract
Background Symptomatic high-grade intracranial atherosclerotic stenosis (sICAS) is associated with a high risk of early recurrent ischemic events despite optimized medical therapy. Conventional angioplasty-to-stent workflows typically require intracranial exchange maneuvers, which may increase procedural complexity and vessel manipulation in perforator-rich territories of the brain. We evaluated the safety and early angiographic outcomes of a standardized, exchange-free, single-pass Gateway balloon-assisted Neuroform Atlas stenting strategy. Methods We retrospectively analyzed consecutive adults with 70–99% sICAS treated at a single center (between January 2018 and January 2025). Following controlled submaximal angioplasty using a Gateway PTA balloon, a Neuroform Atlas stent was deployed directly through the balloon catheter lumen (without microcatheter exchange). Lesion morphology was retrospectively classified according to the Mori system. The primary endpoint was technical success rate. The secondary endpoints were 30-day stroke/intracranial hemorrhage/death and in-stent restenosis (ISR) > 50% on 3-month digital subtraction angiography (DSA). Results Fifty-seven patients (median age, 70 years; 68.4% men) were treated after neurological stabilization (median event-to-stent interval, 9 days; range, 7–15 days); 63.2% had posterior circulation targets. By Mori classification, 2 lesions (3.5%) were Type A, 18 (31.6%) Type B, and 37 (64.9%) Type C. The technical success rate…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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