Objective To analyze the plaque characteristics of patients with recurrent or stable ischemic stroke caused by non-stenotic intracranial atherosclerosis using three dimensional high resolution vessel wall magnetic resonance imaging (3D hr-VW-MRI).Methods A total of 42 patients with ischemic stroke caused by non-stenotic intracranial atherosclerosis in The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jan. 2019 to Aug. 2021 were prospectively enrolled. The patients were examined by 3D hr-VW-MRI within 4 weeks of onset and after 3-month follow-up. Imaging features of plaques, including luminal area, maximum wall thickness and minimum wall thickness at the most stenotic site, stenosis rate, plaque burden, remodeling index, eccentricity index, enhancement ratio at the most stenotic site, enhancement ratio of the whole plaque, plaque volume, and intraplaque hemorrhage, were measured based on plain and contrast-enhanced T1 weighted imaging (T1WI). With regular medical treatment, the patients were divided into recurrent group and stable group according to whether they had transient ischemic attack or cerebral infarction (hyperintensity on cranial magnetic resonance diffusion weighted imaging images with corresponding ischemic stroke symptoms) on the ipsilateral side of the original ischemic stroke. The differences in imaging features of plaques between recurrent group and stable group were analyzed.Results There were 11 patients in the recurrent group and 31 patients in the stable group. The eccentricity index, enhancement ratio at the most stenotic site, enhancement ratio of the whole plaque, plaque volume and intraplaque hemorrhage incidence in the recurrent group were significantly higher than those in the stable group (all P < 0.05). There were no significant differences in the luminal area, maximum wall thickness or minimum wall thickness at the most stenotic site, stenosis rate, plaque burden, or remodeling index between the 2 groups (all P > 0.05).Conclusion 3D hr-VW-MRI can effectively evaluate the plaque characteristics of patients with recurrent ischemic stroke caused by non-stenotic intracranial atherosclerosis, providing reference for clinical prevention of ischemic stroke recurrence.