Endovascular cerebral revascularization is becoming a frequently used alternative to surgery for the treatment of atherosclerotic disease, especially in the intracranial circulation where options are limited. Recent literature regarding the equivalent efficacy of carotid artery stenting and carotid endarterectomy in certain patient populations, as well as the recognition of the significant risk for recurrent stroke posed by intracranial lesions, will only serve to amplify this trend. Hyperperfusion syndrome has been well documented in the setting of carotid endarterectomy; however, a paucity of literature exists regarding the incidence, pathophysiology, and management as it relates to percutaneous interventions. The purpose of this review is to outline the current state of knowledge, with particular attention to the distinct attributes of endovascular treatment that would be expected to modify the course of hyperperfusion syndrome.