Background and Purpose: Angioplasty and stenting is a treatment option for patients with medically refractory symptomatic intracranial atherosclerotic disease (sICAD). Currently the Wingspan Stent System (WSS) is the only FDA approved device for that indication. Nonetheless, our group has shown the Resolute (R) Onyx Stent, a drug-eluting balloon mounted stent (DES), can be feasibly used to treat lesions in this population at lower cost. Herein, we compare the two stents based on our single center experience. Methods: A prospectively maintained neuro-endovascular databased was queried for patients between January 2013 to June 2021. Inclusion criteria for patients included sICAD (≥70% stenosis) with failed medical management, and intracranial stenting with either the R-onyx DES or WSS, including patients treated within 7 days of last stroke. Primary outcomes were assessed via the occurrence of ischemic or hemorrhagic stroke or death within 72 h of the procedure while secondary outcomes consisted of stroke or angiographic reoccurrence (in-stent restenosis) evaluated by a clinical or angiographic follow-up at 6 months. Results: A total of 184 patients, average age 61.26 (SD=12.53) ( 44% women), were eligible for analysis with 58 having R-onyx DES and 126 having WSS. There was no significant difference in age or premorbid risk factors between the two groups. Within 72 h, 1.7% (n=1) of patients had a primary event of ischemic or hemorrhagic stroke or death in the R-onyx DES group while 6.3% (n=8) of patients had those indications in the WSS group (p = 0.089). Among 41 angiographic and clinical follow-ups in the R-onyx DES group, none had a stroke, while among 101 of those follow-ups in the WSS group, 8.9% (n=9) had a stroke (p=0.024). In terms of 6-month angiographic follow-ups, there was a significantly lower rate of symptomatic in-stent restenosis among the R-onyx DES group with 1.7% (n=1) experiencing symptomatic in-stent restenosis, and 21.4% (n=27) in the WSS group having that indication (p=0.0003). Conclusion: Our experience has been that R-onyx DES is more effective at treating sICAD with low rates of periprocedural complications within 72 h, long-term strokes, and symptomatic in-stent restenosis. Future prospective randomized multicenter trials are needed.