Background: Intracranial atherosclerosis - or intracranial atherosclerotic disease (ICAD) - is a dynamic disease characterized by progressing atherosclerotic plaques in major intracranial arteries. Patients with ICAD have a 10 - 20% annual risk of stroke. This study aims at studying the demographic, clinical and imaging characteristics (emphasizing the infarction pattern) in patients with symptomatic ICAD. This cross-sectional study was conducted during the period between November 2021 and July 2022 on patients with acute ischemic stroke caused by intracranial stenosis recruited from the stroke units of Minia University and Kasr Alainy hospitals. All patients were subjected to complete history taking, general examination and meticulous neurological examination. All patients were subjected to brain MRI examination and vascular duplex scanning of extracranial and intracranial Carotid and vertebrobasilar systems. The research was conducted after the approval of the Ethical Review Committee of Faculty of Medicine, Minia University. Results: Forty two patients have been included in this study; 22 males and 20 females ranging in age between 40 to 90 years. Hypertension was the most common risk factor (59 %). The NIHSS ranged from 2 to 20. MCA was the commonest artery to be symptomatically stenotic (42.9%). Territorial pattern was the dominant pattern (59.5%) especially in the anterior circulation, and had the highest NIHSS scores. Conclusion: MCA was the commonest to have symptomatic ICAD. Territorial pattern was the dominant pattern. Territorial pattern had the highest NIHSS scores.