Objective To assess the efficacy and safety of drug therapy alone and stenting for symptomatic intracranial atherosclerotic stenosis (sICAS) in order to provide the best evidence for clinical practice.Methods PubMed,EMbase,Cochrane Library,CBM,CNKI,and Wanfang database were retrieved.The randomized controlled trials (RCTs) on the efficacy and safety of drug therapy and stent-assisted therapy for sICAS were enrolled.The RevMan 5.3 software was used for the meta-analysis.Results A total of 6 RCTs and 782 patients were enrolled.The results of meta-analysis showed that there were no significant differences in stroke or death (odds ratio [OR] 1.61,95％ confidence interval [CI] 0.89-2.91;P=0.12) and fatal stroke within l year (OR 1.60,95％ CI 0.96-2.67,P=0.07) between the stenting group and the drug therapy group.The risks of symptomatic intracerebral hemorrhage (OR 9.51,95％ CI 2.89-31.29;P＜0.01) and any stroke or death (OR 2.15,95％ CI 1.21-3.82;P＜0.01) in the stenting group were higher than those in the drug therapy group.The subgroup analysis showed the risks of any stroke or death within 30 d in the stenting group were significant higher than those in the drug therapy group (OR 2.94.95％ CI 1.55-5.60;P ＜0.01),and there were no sig-nificant differences in anv stroke or death within 1 year (OR 1.90,95％ CI 0.50-7.61;P=0.35) and 2 years (OR 1.38,95％ CI 0.91-2.08;P=0.13);the risks of symptomatic intracerebral hemorrhage within 30 d (OR 10.15,95％ CI 1.92-53.64,P ＜0.01) and within 1 year (OR 8.80,95％ CI 1.60-48.25,P =0.01) in the stenting group were higher than those of the drug therapy group.Conclusions The risks of symptomatic intracerebral hemorrhage and any stroke or death in the stenting group were significantly higher than those in the drug therapy group,therefore,the preferred stenting was not recommended in patients with sICAS.However,stenting still can be considered in patients who failed regular drug therapy and who may benefit greater from stenting.