Introduction Acute ischemic stroke (AIS) due to intracranial atherosclerotic disease (ICAD) carries a high risk of recurrence despite aggressive medical management. While prior revascularization strategies using intracranial stents increased the risk of recurrent stroke in patients with intracranial stenosis, more novel devices, such as the Onyx Frontier^™ stent (Medtronic, Santa Rosa, CA) in a high-risk population may safely augment cerebral perfusion.

Aim of Study The aim of our multicenter study is to present our initial experience with the Onyx Frontier^™ balloon-mounted drug-eluting stent for AIS due to ICAD.

Methods We conducted a multicenter retrospective case series describing the technical feasibility, safety, and performance of using the Onyx Frontier^™ balloon-mounted drug-eluting stent in patients with acute intracranial vessel occlusion due to ICAD.

Results We included 23 patients in our study (mean age 67.3 [10.7]). The most common site of vessel occlusion was the M1 branch of the middle cerebral artery (MCA) (n=14/23, 60.9%), followed by the vertebrobasilar system (n=5/23, 21.7%), and the internal carotid artery (n=3/23, 13.0%). Treatment with the Onyx Frontier^™ zotarolimus-eluting stent was associated with a final mTICI score ≥2b for 100% of patients, with no vessel perforations or distal embolization. None of the patients had any restenosis or re-treatment over a median follow-up of 3.5 months. Transfemoral access was used in most cases (n=18/23, 78.3%), with one in-hospital death due to access site complication (n=1/23, 4.3%).

Conclusion This is the largest multicenter series demonstrating the feasibility and safety of using the Onyx Frontier^™ balloon-mounted stent to treat symptomatic AIS due to ICAD.