Abstract: Intracranial atherosclerotic stenosis (ICAS) is a leading cause of ischemic stroke, especially in Asia. Since the publication of high-quality randomized controlled trials conducted by the United States in 2011, ICAS has been a subject of controversy and concerns. Recently, the results of a randomized controlled trial published in the leading international medical journal compare the effectiveness of endovascular treatment and medical treatment for ICAS in the Chinese population, which has reattracted public attention to this issue. Endovascular therapy is not inferior to medical treatment, and the benefits of endovascular therapy may be greater in drug-refractory patients with hemodynamic disorders.Therefore, this paper systematically discusses ICAS disease characteristics, treatment status, and future directions, suggesting that endovascular therapy may be of further benefit to drug-refractory patients with hemodynamic disorders, and stricter medical management and improved patient compliance will further reduce stroke recurrences and mortality.