Intracranial atherosclerosis presents a therapeutic challenge to medical and surgical physicians alike. Despite maximal medical
therapy, the
stroke rate from this disease is still high, especially when arterial
stenosis is severe and patients are symptomatic. Open surgical
therapy has yet to be shown to be a more efficacious treatment than medical
therapy alone, largely due to the relatively high rates of perioperative complications. Angioplasty has a similar fate, with the risk of periprocedural complications outweighing the overall benefit of treatment. With the advent of
stents for use in intracranial vasculature, new hope has arisen for the treatment of
intracranial atherosclerosis. The NEUROLINK system, the
drug-eluting stents Taxus and Cypher, the flexible Wingspan
stent, the Apollo
stent, and the Pharos
stent have all been used in various prospective and retrospective clinical studies with varying technical and clinical results. The authors' objective is to review and loosely compare the data presented for each of these stenting systems. While the Wingspan
stent appears to have somewhat of an advantage with regard to technical success in comparison with the other stenting systems, the clinical follow-up time of its studies is too short to properly compare its complication rates with those of other
stents. Before we continue to move forward with stenting for intracranial
stenosis, a randomized prospective trial is ultimately needed to directly compare intracranial stenting to medical
therapy.