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Background Intracranial atherosclerotic disease (ICAD) remains a leading cause of ischemic stroke globally, with particularly high prevalence in Asian populations. While aggressive medical therapy is first-line management, recurrent ischemia persists in a subset of patients. Advances in stent technology, including fibrin-heparin surface modification, aim to improve hemocompatibility and reduce thromboembolic risk. However, real-world data on next-generation devices remain limited, particularly in low- and middle-income settings.Objective To evaluate the safety, technical feasibility, and mid-term outcomes of elective intracranial stenting using the CREDO® heal device in patients with symptomatic high-grade ICAD.Methods We performed a retrospective two-center observational study including 45 consecutive patients with ≥70% symptomatic intracranial stenosis treated electively with the CREDO® heal stent between May 2023 and September 2024. All patients received best medical therapy and underwent a standardized stepwise protocol with mandatory submaximal angioplasty followed by stent deployment. Primary safety outcome was stroke, intracranial hemorrhage, or death within 30 days. Secondary outcomes included technical success (residual stenosis ≤30%), vessel patency, recurrent ischemia, and functional outcome measured by modified Rankin Scale (mRS) at discharge and follow-up.Results Technical success was achieved in all procedures with stenosis reduction from severe pre-treatment levels to ≤30% post-stenting. No periprocedural stroke, intracranial hemorrhage, or mortality occurred within 30 days. Imaging follow-up demonstrated sustained vessel patency without restenosis or stent thrombosis through 6-12 months. Functional outcomes improved progressively, with favorable mRS (≤2) observed in the majority of patients and increasing rates of functional independence over time.Conclusions In this early real-world experience, elective stenting with the CREDO® heal device demonstrated excellent technical success and encouraging safety with durable mid-term patency. These findings support the feasibility of contemporary ICAD stenting in carefully selected patients and highlight the potential value of next-generation coated devices. Larger prospective studies are warranted to confirm long-term efficacy and comparative effectiveness.Disclosures A. Maidan: None. M. Berdikhojayev: None.