OBJECTIVE: Primary stenting is a well-established treatment for coronary artery disease and has been applied to symptomatic intracranial stenosis in selected patients. This study reports a large case series of middle cerebral artery revascularization using balloon-mounted coronary stents. METHODS: The series consisted of 113 consecutive patients with symptomatic mid; middle cerebral artery stenosis and more than 70% occlusion who underwent intracranial stenting at a single center from 2001 to 2006. Technical success, periprocedural complications, recurrent symptoms, and restenosis were retrospectively reviewed. Risk factors for restenosis were analyzed using logistic regression and the chi(2) test. RESULTS: The mean age of the patients was 48 +/- 11 years (range, 25-79 years). Seventy-three patients presented with transient ischemic attacks, and 40 patients were diagnosed with acute stroke. The technical success rate was 96.46%. The mean stenosis was reduced from 80.83 +/- 8.77% to 3.71 +/- 8.15%. The rate of stroke and death within 30 days was 4.42%. Eighty-nine patients were followed for an average period of 29 +/- 16 months (range, 9 months-5 years). Seventy-nine vessels were followed with transcranial Doppler and 36 vessels with angiography or computed tomographic angiography. Recurrent stroke or transient ischemic attacks occurred in 6 patients (6.74%). The restenosis rate was 20.25%. Restenosis was associated with diabetes and hyperlipidemia but not with age, sex, hypertension, or drug-eluting stent. CONCLUSION: Primary stenting of symptomatic middle cerebral artery stenosis can be performed with high success and low complication rates. Randomized clinical studies are warranted to compare the safety and efficacy of various endovascular revascularization techniques with maximal medical therapy in patients with symptomatic intracranial atherosclerosis.