Abstract: Objective To investigate the characteristics of vertebral-basal atherosclerotic plaque under high-resolution magnetic resonance imaging in patients with posterior circulation ischemic stroke. Methods The clinical and imaging characteristics of 76 patients(128 plaques in total)with posterior circulation ischemia were retrospectively analyzed. According to imaging data, symptoms and signs of patients, they were divided into stroke group(n=42, 81 plaques)and non-stroke group(n=34, 47 plaques). Brain vascular examination was performed using HR-MRI. The general information, plaque distribution, and HR-MRI characteristics of plaques in the two groups were analyzed. Results There were significant differences in diabetes, hypertension and hyperlipidemia between the two groups(P<0.05). Plaques usually occur in the left vertebral artery and basilar artery, but no difference in the distribution of atherosclerotic plaque between the two groups was found(P>0.05). The ratios of patients with plaque load and plaque enhancement in the stroke group were significantly higher than that in the non-stroke group(P<0.05). Conclusion The vertebral-basal arteries are the most frequently affected posterior circulation vessels. Analysis of the HR-MRI characteristics of the vertebral-basal artery atherosclerotic plaques in patients with posterior circulation ischemic stroke can help to understand the degree of risk and prognosis.