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Over the past two decades, substantial progress has been made in the endovascular treatment of symptomatic intracranial atherosclerotic stenosis (sICAS). In this study, we performed a comprehensive review focusing on patient selection criteria, advanced imaging modalities for lesion characterisation, evolving endovascular therapeutic approaches, the innovation of next-generation neurointerventional devices, and the evidence-based recommendations outlined in clinical guidelines and expert consensus statements for the treatment of sICAS.