OBJECTIVE: To compare the technical and 1-year clinical outcome in balloon-mounted versus self-expanding stenting for symptomatic severe stenosis of the middle cerebral artery combined with poor collaterals in China. METHODS: Ninety-one patients with severe middle cerebral artery atherosclerotic stenosis combined with poor collaterals were recruited in the study. Balloon-mounted stent or self-expanding stent were selected to treat patients following a guideline. The baseline characteristics, cerebral angiography, and outcomes were compared between the patients treated with balloon-mounted stent and self-expanding stent. RESULTS: The mean degree of stenosis was 85.5% +/- 6.37% in the balloon-mounted stenting group and 85.4% +/- 7.73% in the self-expanding stenting group before treatment (P = 0.930). A longer operative time occurred in patients treated with self-expanding stent than in those treated with balloon-mounted stent (96.7 vs. 68.6 minutes, respectively; P = 0.002). Patients with self-expanding stent had a higher rate of residual stenosis than those with balloon-mounted stent (67.3% vs. 38.9%, respectively; P = 0.014). The patients in balloon-mounted stenting group was less likely to have restenosis (6.1% vs. 26.5%, P = 0.019) and had a lower degree of stenosis (5.0% +/- 0.0% vs. 26.9% +/- 29.2%, P = 0.019) compared with patients in the selfexpanding stenting group. During the 1-year follow-up, the recurrence rate of ischemic stroke, transient ischemic attack, hemorrhage stroke, and death was not significantly different between the 2 groups (1/33 vs. 2/49, P = 0.804; 1/33 vs. 1/49, P = 0.776; 0/33 vs. 2/49, P = 0.240; 1/33 vs. 0/49, P = 0.220, respectively). CONCLUSIONS: Balloon-mounted stents may have a shorter operative time and lower restenosis occurrence than self-expanding stents. No significant difference in 1-year outcome was observed between the 2 groups.