The SAMMPRIS and VISSIT trials were initiated to compare aggressive medical treatment vs. intracranial stenting in patients with symptomatic, severe ICAD. Both trials concluded that medical therapy was better than intracranial stenting. In contrary, a single-center randomized controlled trial in China, that randomized patients with stroke or TIA attributable to significant Middle Cerebral Artery (MCA) stenosis, to either endovascular or aggressive medical treatment concluded that endovascular treatment could be safe and efficient treatment modality for carefully selected patients with MCA stenosis