Endovascular treatment of symptomatic intracranial atherosclerotic stenosis: preliminary findings from a single-center clinical series of angioplasty and stenting using the Coyote balloon catheter

Data on the clinical efficacy and safety of the Coyote balloon catheter for symptomatic intracranial atherosclerotic stenosis (sICAS) are lacking. This study reports preliminary findings from the first clinical series evaluating this device, with the aim of describing procedural outcomes and 6-month restenosis rates. This retrospective study included 32 patients (39 lesions) who underwent elective endovascular treatment for sICAS at the Interventional Radiology unit of our institution between July 2024 and December 2025. The primary endpoints were acute technical success (successful device delivery, residual stenosis < 50%, and TICI 2b/3 flow) and 30-day procedural success (technical success without 30-day stroke or death). Secondary endpoints included 6-month restenosis and 1-year target-vessel stroke. The stroke rate during the first month was 5.1% per procedure (6.3% per patient). At 6-month follow-up, restenosis was observed in 7.9% of lesions. Technical success was achieved in 100% of lesions, with all cases obtaining TICI 2b/3 distal perfusion. The mean degree of stenosis significantly decreased from 88.08% preoperatively to 30.12% postoperatively (p < 0.001). The perioperative complication rate was 2.6%. The 30-day procedural success rate was 94.9%, as minor periprocedural strokes occurred in 2 cases (5.1%). This clinical series demonstrates that the Coyote balloon catheter is technically feasible in sICAS with a favorable safety profile. The observed restenosis and stroke rates indicate a viable option for intracranial angioplasty, providing descriptive data for future prospective investigations. Clinical series: Evaluation of the Coyote balloon catheter in sICAS treatment.High technical success: Achievement of 100% technical success and luminal clearance in complex lesions.High safety profile: Low perioperative complications and per-procedure stroke rate.Low restenosis risk: A restenosis rate of 7.9% at the 6-month follow-up suggests favorable mid-term durability. Clinical series: Evaluation of the Coyote balloon catheter in sICAS treatment. High technical success: Achievement of 100% technical success and luminal clearance in complex lesions. High safety profile: Low perioperative complications and per-procedure stroke rate. Low restenosis risk: A restenosis rate of 7.9% at the 6-month follow-up suggests favorable mid-term durability.