Cerebral ischemia is due to either embolic or cerebrovascular occlusive disease, which most commonly occurs as a manifestation of atherosclerosis. Although carotid endarterectomy has been proven more effective than medical therapy in the treatment of cervical carotid disease, there are no effective surgical strategies for the management of vertebral artery or intracranial carotid disease. Management of patients with these conditions is well suited to a multidisciplinary team with the combined skills to provide optimal care. Percutaneous revascularization techniques with balloon angioplasty and stenting can be used to successfully treat occlusive disease of the vertebral and intracranial arteries. Percutaneous revascularization of intracranial and vertebral vessels with angioplasty and stenting is an effective strategy. The outcomes in this difficult to manage cohort of patients appears to be markedly improved over the natural history of this disease with medical therapy alone.