INTERVENTIONAL NEURORADIOLOGY Treatment of symptomatic high-grade intracranial stenoses with the balloon-expandable Pharos stent: initial experience W. Kurre & J. Berkefeld & M. Sitzer & T. Neumann-Haefelin & R. du Mesnil de Rochemont Received: 12 February 2008 / Accepted: 27 March 2008 / Published online: 26 April 2008 # Springer-Verlag 2008 Abstract Introduction We report our first clinical experience with a CE-marked flexible monorail balloon-expandable stent for treatment of high-grade intracranial stenoses. Methods Between April 2006 and November 2007 21 patients with symptomatic intracranial stenoses (>70%) were treated with the PHAROS stent. In seven patients, the procedure was performed during acute stroke intervention. Procedural success, clinical complication rates and mid- term follow-up data were prospectively recorded. Results During a median follow-up period of 7.3 months one additional patient died of an unknown cause 3 months after the intervention. A patient with a significant residual stenosis presented with a new stroke after further progres- sion of the residual stenosis. None of the successfully treated patients experienced ipsilateral stroke. Conclusion Recanalization of intracranial stenoses with the balloon-expandable Pharos stent is technically feasible. The periprocedural complication rate and mid-term follow-up results were in the range of previously reported case series. This pilot study was limited by the small sample size and severe morbidity of the included patients. Final evaluation of the efficacy of Pharos stent treatment demands further investigation. Keywords Intracranial stenosis . Intracranial stenting . Pharos stent . Balloon-expandable stent Introduction Balloon angioplasty of intracranial atherosclerotic stenoses bears the risk of residual obstruction caused by elastic recoil or dissection. Primary stenting may overcome these problems and is increasingly used to treat symptomatic patients with intracranial atherosclerotic disease [1–3]. Pioneering work was done either with balloon-expandable coronary stents used “off-label” or with modified coronary devices in approval studies. These studies and case series showed a wide range of complication rates and variable short-term follow-up results and raised doubts concerning the clinical effectiveness of the treatment [4–12]. Hemor- rhage caused by arterial rupture, guide-wire perforation or reperfusion injury and ischemic stroke due to perforator compromise were the main hazards contributing to consid- erable morbidity and mortality rates of the procedure. Reported event rates during mid- and long-term follow-up and restenosis rates also showed a wide variation among different studies [4, 13–15]. Therefore, endovascular treatment for prevention of stroke has not yet been shown to be effective from a scientific perspective. However, the high stroke risk of symptomatic intracranial stenoses justifies stent angioplasty in selected cases, especially in patients with high-grade ≥70% stenosis, recurrent symp- toms or severe hemodynamic compromise [16–18]. Since 2006 some devices have been tested and approved for intracranial use [19, 20]. One of these stents is the Neuroradiology (2008) 50:701–708 DOI 10.1007/s00234-008-0394-6 W. Kurre (*) : J. Berkefeld : R. du Mesnil de Rochemont Department of Neuroradiology, University of Frankfurt, Schleusenweg 2–16, 60528 Frankfurt, Germany e-mail: wiebke.kurre@kgu.de M. Sitzer Department of Neurology, Klinikum Herford, Herford, Germany T. Neumann-Haefelin Department of Neurology, University of Frankfurt, Frankfurt, Germany