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Thirty-five patients with high-grade, symptomatic intracranial stenosis and poor antegrade flow, treated with intracranial angioplasty without stent placement from January 2010 to December 2016, were retrospectively reviewed. The main outcomes included the changes in antegrade flow and residual stenosis and any stroke or death within 1 month. The average preprocedure stenosis was 88%. The immediate, average postprocedure stenosis rate was 25%, and the average postprocedure stenosis rate at last angiographic follow-up was 35%. The primary end point of major stroke or death at 30 days was observed in 1 patient (1/35, 2.9%), and no patient had intraprocedural complications. The authors conclude that primary balloon angioplasty was an effective treatment option for symptomatic intracranial stenosis with a high risk of stroke.