Tenzingplasty for symptomatic, non-occlusive intracranial atherosclerotic disease after maximal medical therapy failure

Objective: Intracranial atherosclerotic disease (ICAD) is an important cause of ischemic stroke. Balloon angioplasty for ICAD with or without a stent is associated with a high complication rate. The Tenzing support catheter (Route92 Medical) is a tapering offset catheter designed for improving aspiration catheter delivery in large vessel occlusion ischemic stroke (LVO). In LVO secondary to ICAD, we noted that the Tenzing could be used for angioplasty. In this study, we report our experience with the Tenzing angioplasty technique (T-Plasty) for ICAD treatment in the absence of LVO. Methods: A prospectively maintained database of all adult ICAD patients without LVO treated with T-Plasty at our institution was reviewed. Information on demographics, procedural details, clinical outcomes, and complications is reported here based on the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Student's T-test was applied to evaluate for statistical significance when appropriate. Results: From September 2024 to April 2025, 18 adult patients underwent T-Plasty for symptomatic ICAD without LVO. All patients experienced an improvement; the early cohort had a 4.5 points reduction in NIHSS immediate post T-Plasty, and both the elective and early cohorts experienced close to 1 point improvement in baseline mRS. No operative or post-operative related complications were noted up to 30-day follow-up. Conclusions: T-Plasty for the elective treatment of chronic symptomatic ICAD and acute hypoperfusion syndrome is an option for improving neurologic outcome.