The clinical application of a low-profile stent for symptomatic intracranial atherosclerotic stenosis in the middle cerebral artery: a retrospective study of the Atlas stent

Abstract

Background Intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke, conferring high recurrence risk especially among East Asian populations. Landmark trials revealed limitations of Wingspan stenting, including restenosis concerns. The low-profile, flexible Neuroform Atlas stent, initially designed for intracranial aneurysms, may be suitable for tortuous intracranial vessels, yet its real-world evidence for middle cerebral artery (MCA)-segment symptomatic ICAS (sICAS) remains insufficient. This study aimed to evaluate the safety and efficacy of the Neuroform Atlas stent for treating sICAS involving the MCA M1-M2 segment and explore the clinical value of individualized balloon dilation strategies. Methods A retrospective analysis was conducted on 22 consecutive patients with severe sICAS (70–99% stenosis) in the MCA M1-M2 segment, who were treated with the Neuroform Atlas stent at our center between November 2021 and June 2025. The primary endpoints were technical success rate, perioperative complications, and improvement in vascular stenosis immediately after the procedure and at the 6-month follow-up, including the incidence of in-stent restenosis. An exploratory analysis was performed on cases with different balloon dilation strategies. Results The technical success rate was 100% in all 22 cases, with no perioperative stroke or death. The mean preprocedural stenosis rate was 80.86%±9.82%, which decreased immediately after the procedure to 32.34%±10.36% (P<0.01). Among the 19 patients who completed imaging follow-up, the mean residual stenosis rate at 6 months was 38.43%±21.39%, showing no statistically significant difference compared with the immediate postprocedural value (P>0.05). The restenosis rate was 10.53% (2/19), with both cases being asymptomatic and occurring in Mori type B or C lesions. The multiple balloon dilation group had a higher baseline stenosis degree, but no statistically significant difference was observed between the two groups in either the immediate postprocedural residual stenosis rate or the 6-month residual stenosis rate. Conclusions The Neuroform Atlas stent is safe and effective for treating sICAS in the MCA M1-M2 segment. An individualized balloon predilation strategy can optimize immediate lumen reconstruction for complex lesions without significantly affecting long-term patency. The inherent complexity of the lesion itself may be associated with postoperative restenosis.