Symptomatic intracranial atherosclerotic stenosis (sICAS) is one of the major cause of ischemic stroke

and very prevalent among African

Asian

and Hispanic populations. The occurrence of sICAS is correlated to some risk factors

which include the degree of arterial stenosis

advancing age

systolic hypertension

diabetes mellitus

high levels of low-density lipoprotein cholesterol

and metabolic syndrome. The annual risk of stroke recurrence in the presence of sICAS may exceed 20% when the degree of luminal narrowing is 70% or more. It is controversy whether there is a specific type of treatment other than medical management (including aggressive control of vascular risk factors and antiplatelet therapy) that may alter the high risk of stroke recurrence among patients with sICAS. Endovascular treatment has been thought to be helpful in patients who fail to respond to medical treatment alone

but recent data contradict such expectation.