Neuroform Atlas Stent for middle cerebral artery Stenting of Symptomatic Intracranial Atherosclerotic Stenosis: A Multi-Center Retrospective Study

BACKGROUND AND PURPOSE: This study aims to assess the safety and efficacy of the Neuroform Atlas stent in treating symptomatic MCA stenosis, hypothesizing that its advanced design may lead to more favorable outcomes in this high-risk patient population. MATERIALS AND METHODS: Consecutive patients who underwent endovascular stenting for symptomatic intracranial atherosclerotic stenosis (ICAS) of the middle cerebral artery (MCA) from January 2020 to December 2025 were screened for inclusion. The Neuroform Atlas stent system was deployed in MCA. All patients were followed up for at least six months with vascular imaging (CTA or DSA). The primary efficacy endpoint was the rate of favorable clinical outcomes, defined as an mRS score ≤3, at six months post-procedure. RESULTS: A total of 165 consecutive patients who underwent endovascular stenting for symptomatic MCA stenosis were included in this analysis. At the 6-month follow-up, 145 patients (87.9%) were classified as having a favorable clinical outcome, while 20 patients (12.1%) had an unfavorable outcome. The multivariate logistic regression analysis confirmed that a higher pre-procedural stenosis rate (OR: 1.14, 95% CI: 1.03-1.26, p = 0.01), greater lesion length (OR: 4.18, 95% CI: 1.32-12.26, p = 0.01), a higher admission NIHSS score (OR: 1.27, 95% CI: 1.04-1.54, p = 0.02), and most importantly, lesion location at the M1 bifurcation (distal third) (OR: 16.21, 95% CI: 2.86-91.96, p = 0.002) were independent risk factors for an unfavorable clinical prognosis. CONCLUSION: The stenting of symptomatic MCA stenosis with the Neuroform Atlas stent system was associated with high technical success, a favorable short-term safety profile, and promising efficacy outcomes.