Safety and efficacy of self-expanding stents for symptomatic severe intracranial posterior circulation stenosis: a two-center prospective cohort study

Background Intracranial atherosclerotic stenosis (ICAS) of the posterior circulation is a common neurological condition, and the efficacy of endovascular therapy remains controversial.Methods In this two-center prospective cohort study, 120 consecutive patients with severe posterior circulation ICAS were enrolled and divided into a stent group or a medication group based on clinical decision-making. To minimize selection bias, propensity score matching (PSM) was also applied to balance baseline covariates between the two groups. Clinical outcomes and angiographic follow-up were assessed at 6 months.Results At the 6-month follow-up, the stent group exhibited significantly lower vascular stenosis rates (35.58 ± 12.25% vs. 78.00 ± 7.82%, p < 0.001) and NIHSS scores (0.80 ± 0.73 vs. 1.38 ± 1.19, p = 0.002) compared to the medication group. A significantly higher proportion of patients in the stent group achieved a Barthel Index ≥60 (59 vs. 52, p = 0.038). Additionally, the relief of dizziness was significantly superior in the stent group (p = 0.032). Asymptomatic in-stent restenosis occurred in 3 cases in the stent group, with no recurrent cerebral infarctions observed, whereas 2 recurrent strokes occurred in the medication group.Conclusion Self-expanding stenting is a safe and effective strategy for symptomatic severe posterior circulation ICAS, improving vascular patency while showing potential benefits for neurological recovery.