The Gateway balloon-Wingspan stent system is the first, and currently the only "on-label" device for the treatment of symptomatic intracranial stenosis in the United States. In initial single-arm studies, investigators have indicated that this system can be used for the treatment of symptomatic intracranial atherosclerotic disease with high levels of technical success and acceptable periprocedural complication rates, which are comparable with, or better than, those reported for other endovascular techniques. Intermediate- and long-term follow-up data for patients treated with the Wingspan device remain sparse. We critically review the existing data, which characterize the risk profile and efficacy of endovascular interventions for intracranial atherosclerotic disease, as well as the available clinical evidence that could be used to select appropriate patients for treatment.