Background: Intracranial atherosclerosis (ICAS) is one of the main causes of ischemic stroke. The optimal therapy for symptomatic ICAS with stenosis >70% is not well established yet. Angioplasty with or without stent has been attempted, with controversial results, which mainly be attributed to intraprocedural adverse events, and a high rate of restenosis or in-stent restenosis. Objective: To investigate efficacy and safety of primary angioplasty with or without stent placement for management of ICAS diseases by comparing angiographic and clinical outcome of both groups. Patients and Methods: Data from 59 patients with symptomatic ICAS (70-99% stenosis) were prospectively collected from the Department of Neurology at Al-Hussein and New Damietta Al-Azhar University Hospitals. Interventional Procedure was performed (primary angioplasty for 19/59 and stent placement for 40/59) according to location and size of stenosis. Data of intraprocedural adverse events and clinical and angiographic follow-up outcomes were analyzed. Results: A total of 59 patients were included in our study. There were 32 (54.2%) males and 27 (45.7%) females. The mean age was 63.66 ± 8.264. Successful revascularization (Residual stenosis <30%) was obtained in all patients of the angioplasty group (19/19) compared to 92.5% of patients in the stent group (P-value=.544). Intraprocedural adverse events were significantly higher in the stent-treated group 12/40 (30%) than in the angioplasty-treated group 1/19 (5.3%). There was no statistical significance between the outcome parameters and type of interventional treatment except in restenosis (≥50%) at median radiological follow-up of 12.5 months, which was higher in the angioplasty-treated group 6/19 (31.6%) than in the stent-treated group 3/40 (7.5%). Conclusions: Intracranial angioplasty with or without stenting for management of symptomatic intracranial atheromatous disease was associated with a high rate of technical success.