Balloon angioplasty plus aggressive medical management significantly reduced the risk of a composite outcome of any stroke or death in patients with symptomatic intracranial atherosclerotic stenosis (sICAS), researchers report. Their randomized controlled trial, which was conducted at 31 centers across China, included patients aged 35-80 years with sICAS, defined as having a recent transient ischemic attack or ischemic stroke associated with a 70%-99% atherosclerotic stenosis of a major intracranial artery receiving treatment with antithrombotic medication and/or standard risk factor management. The 501 patients were randomized to submaximal balloon angioplasty plus aggressive medical management (n=249) or aggressive medical management only (n-252), which featured dual antiplatelet therapy for the first 90 days and risk factor control. The balloon angioplasty group had a significantly lower rate of composite stroke or death within 30 days compared with the aggressive medical management group, at 4.4% vs 13.5%. For any stroke or all-cause death within 30 days, the rates were 3.2% and 1.6%, respectively. The rates of any ischemic stroke in the qualifying artery territory were 0.4% and 7.5%, respectively, from 30 days to 1 year after enrollment. Revascularization of the qualifying artery occurred in 1.2% of the balloon angiography group and 8.3% of the aggressive medical management group. Symptomatic intracranial hemorrhage rates in the two groups were 1.2% and 0.4%, respectively. Procedural complications occurred in 17.4% of patients in the balloon angiography group, while arterial dissection occurred in 14.5%.