BACKGROUND: The conventional management of the symptomatic stenosis of intracranial artery is the administration of antithrombotic agents while controlling the vascular risk factors. Despite medical therapy, the stroke risk for patients with intracranial artery stenosis remains high. Recently, balloon angioplasty with or without stent placement has emerged as a potential therapeutic option. This study was aimed to assess the efficacy, safety and clinical outcome of balloon angioplasty without stent placement for patients with symptomatic middle cerebral artery (MCA) stenosis. METHODS: Between February 1996 and December 2004, 41 cases (40 consecutive patients) with symptomatic MCA stenosis greater than 50% were treated with balloon angioplasty. Patient records were retrospectively reviewed for angiographic findings, periprocedural complications, and long-term outcome. RESULTS: Mean stenosis rate (75.4%) was significantly reduced after the procedure (26.6%). The procedure revealed that 4 of the 41 (9.7%) patients developed major related complications (one death and 3 minor strokes). Other minor related complications were also observed in 7 patients, which included 3 transient neurological deficits, 3 asymptomatic dissections and 1 asymptomatic petechial hemorrhage. During the follow-up period (2-108 months), none of the patients developed ischemic stroke in the territory of treated MCA, however one patient developed TIA at the 12 month after angioplasty. CONCLUSIONS: Angioplasty without stent placement is technically feasible, safe and effective in the patients with symptomatic MCA stenosis.