Atherothrombotic occlusive disease of the intracranial arteries is common in Japan, Asia, and black people. In 1,046 patients with acute atherothrombotic brain infarction between 2006 and 2008, intracranial arterial occlusion (53%) was more common than extracranial occlusion (47%). In patients with intracranial occlusion, occlusion of the middle cerebral artery occupied 59%, that of the vertebral artery 16%, that of the posterior artery 14%, the basilar artery 10% and the anterior cerebral artery 1%. In acute phase of atherothrombotic stroke, tissue plasminogen activator may be applied within 3 hours of onset, edaravone within 24 hours, argatroban within 48 hours, ozagrel sodium with heparin within 5 days, and oral antiplatelet agents at anytime. Hemodilusion therapy, statin treatment, and therapy against brain edema are also considered. After acute phase, to prevent recurrent attacks, appropriate oral antiplatelet agents, such as aspirin (75–150mg/day), clopidogrel (50–75mg/day), or cilostazol (100–200mg/day) are administered. Control of risk factors, hypertension (blood pressure less than 140/90mmHg), diabetes mellitus (HbA1c less than 7.0%, dyslipidemia [LDL cholesterol less than 120mg/dl]) are quite important. Cessation of smoking habit is also strongly required.