Intracranial atherosclerotic disease (ICAD) is one of the leading causes of ischemic stroke worldwide. Despite advances in its diagnosis and management, there is no clear consensus on best practices to manage ICAD. This report summarizes the ARISE II (Roundtable Discussion With Industry and Stroke Experts) consensus in treating ICAD. The consensus underscored the importance of lifestyle modification and medical management in patients with ICAD. Patients who fail medical management are candidates for endovascular treatment. Open surgery is not recommended in patients who lack demonstrated hemodynamic insufficiency. The consensus also identified gaps in knowledge about the optimal duration of antithrombotics, the effect of the CYP2C19 genotype on medical management, the need for newer devices, and the standardization of antithrombotic protocols before stenting in an acute setting. Optical coherence tomography requires additional clinical data before defining its role in the diagnosis of ICAD.