Dilation of stenoses of the major intracranial arteries is now technically possible in many cases. Using proper precautions, most procedures can be performed without complications today, but the safety margin will likely be improved with refinement of current devices and the introduction of new devices made specifically for this indication. Early experience with these techniques is promising for lowering the risk for recurrent ischemic events in patients who have symptomatic intracranial arterial stenosis refractory to medical therapy. This article describes the steps taken to perform transluminal balloon angioplasty and stent-assisted angioplasty for intracranial atherosclerotic stenosis, from patient preparation through follow-up, including procedural steps and device selection.