Objective To investigate the safety and efficacy of individualized endovascular treatment in patients with symptomatic intracranial atherosclerotic stenosis (sICAS). Methods The clinical data of sICAS patients who received individualized endovascular treatment in our hospital from Jan. 2019 to Dec. 2022 were retrospectively collected. The success rate of revascularization, the perioperative complications and death, and the incidence of recurrent ischemic stroke (IS), transient ischemic attack, death and restenosis during follow-up were analyzed. Results There were 55 lesions of 52 sICAS patients, and they all received endovascular treatment. The mean age was (62.94±9.04) years old. The preoperative stenosis severity was 90 % (80 %, 99 %) and the stenosis length was 8 (5, 11) mm. The surgical methods were balloon-mounted stenting (25 cases, 27 lesions), self-expanding stenting (19 cases, 20 lesions), and simple balloon dilation angioplasty (8 cases, 8 lesions). The postoperative residual stenosis severity was 10 % (0, 20 %), which was significantly lower than that before surgery (P<0.001). The success rate of revascularization was 94.23 % (49/52). The incidence of perioperative complications was 3.85 % (2/52). The clinical follow-up time was 12 (12, 18) months and the imaging follow-up time was 10 (6, 12) months. During the follow-up period, the incidence of vascular restenosis was 7.69 % (4/52), the incidence of recurrent IS was 1.92 % (1/52), and there was no death. Conclusion Individualized endovascular treatment is safe and effective for sICAS patients. It can improve the success rate of revascularization and reduce perioperative complications, long-term recurrence rate of IS and risk of restenosis.