AbstractBackground and PurposeThere are limited data regarding the comparison of balloon expandable stents (BES) and self‐expanding stents (SES) for the treatment of intracranial arterial stenosis.MethodsWe conducted a systematic review to identify studies that compared SES and BES in patients with symptomatic intracranial arterial stenosis. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until from January 1, 2010 to September 28, 2023. Statistical pooling with random‐effects meta‐analysis was undertaken to compare the rates/severity of postprocedure stenosis, technical success, 30‐day stroke and/or death, cumulative clinical endpoints, and restenosis rates.ResultsA total of 20 studies were included. The standardized mean difference (SMD) for postprocedure stenosis (%) was significantly lower (SMD: −0.52, 95% confidence interval [CI]: −0.79 to −0.24, p < .001, 10 studies involving 1515 patients) with BES. The odds for 30‐day stroke and/or death were significantly lower (odds ratio [OR] 0.68, 95% CI: 0.50‐0.94, p = .019, 15 studies involving 2431 patients), and cumulative clinical endpoints on follow‐up were nonsignificantly lower (OR 0.64, 95% CI: 0.30‐1.37, p = .250, 10 studies involving 947 patients) with BES. The odds for restenosis during follow‐up were significantly lower (OR 0.50, 95% CI: 0.31‐0.80, p = .004, 13 studies involving 1115 patients) with BES.ConclusionsCompared with SES, BES were associated with lower rates of postprocedure 30‐day stroke and/or death with lower rates of restenosis during follow up and the treatment of symptomatic intracranial arterial stenosis.