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Objective We describe a case of intracranial giant cell arteritis (GCA) causing recurrent ischaemic strokes refractory to medical management that ultimately responded to intracranial stenting.Case A 69-year-old lady presented with transient expressive dysphasia following two weeks of temporal headaches, scalp allodynia and jaw claudication. Temporal artery biopsy was consistent with GCA. Multimodal angiography identified bilateral, high-grade stenosis of the distal internal carotid and vertebral arteries consistent with intracranial vasculitis. Recurrent infarcts occurred despite high-dose steroids, tocilizumab, cyclophosphamide and dual antiplatelets. Acute deterioration necessitated emergent angioplasty and stenting of bilateral internal carotid arteries, which led to resolution of the major neurological deficits. No further clinical episodes occurred.Discussion Stroke is rare in GCA, occurring in <10% of cases but over 50% may have intracranial vessel involvement on MRI so the true prevalence of intracranial GCA may be underestimated. The internal carotid arteries and distal vertebral arteries (V4) are most commonly affected. Antiplatelets have demonstrated success in case reports but lack trial data. The optimal immunosuppressive regimen is unknown. Combination immunosuppression may be more effective than corticosteroid monotherapy, but outcomes remain poor with survival rates <50% reported. There is limited experience with endovascular intervention. It has been shown to immediately improve luminal diameter, but restenosis risk may be higher than in atherosclerosis because of overexpression of platelet-derived growth factor.Conclusion This case illustrates the difficulty of managing intracranial GCA and highlights the role of endovascular intervention as a potential rescue therapy.