Objective To investigate the intracranial vascular lesions in patients with subcortical infarction-induced vascular cognitive impairment(VCI), and to investigate the etiology and mechanisms of VCI. Methods Inpatients with subcortical infarction in our hospital were enrolled in this study from Nov. 2012 to Feb. 2014, with those unable to complete the cognitive evaluation eliminated. According to the diagnostic criteria of VCI the patients were divided into two groups: 49 with cognitive impairment (VCI group) and 42 without cognitive impairment (NVCI group). The clinical data, physical examinations, laboratory tests, and the Montreal Cognitive Assessment (MoCA) scale scores were collected. Cerebral blood vessels were assessed by CT angiography or magnetic resonance angiography (MRA). Results The results showed that, according to TOAST classification, VCI group had 24 (48.98%) patients with large artery atherosclerosis (LAA) and NVCI group had 22 (52.38%), showing no significant difference between the two groups. CTA or MRA indicated that 37 (75.51%) patients in VCI group had vascular stenosis, with 75.25% of the 37 patients having intracranial vascular stenosis and 28.71% with middle cerebral artery stenosis. Patients with single cerebral artery stenosis accounted for 18.37% and those with the multiple artery stenosis accounted for 57.14%. CTA or MRA indicated that 34 (80.95%) patients in NVCI group had vascular stenosis, with 60% having intracranial vascular stenosis, including 32% with middle cerebral artery stenosis, 26.19% with single cerebral artery stenosis, and 54.76% with the multiple artery stenosis, with the latter two data being significantly different from the VCI group (P <0.05). In VCI group, the number of intracranial vascular stenosis branches ranged 0-6, with a mean of (1.51±1.67), and a negative relation was found between numbers of stenosis arteries and MoCA scores in patients of VCI group (r_s=-0.283, P <0.05). Conclusion Different from the common causes of small blood vessels, LAA is the most common etiology of subcortical VCI, which implied that exploring the LAA causes of small lesions is crucial for the prevention of VCI in Chinese patients.