Objective: To investigate the relationship between middle cerebral artery(MCA) plaque features on high-resolution vessel wall imaging(HR-VWI) and acute ischemic stroke/TIA recurrence. Methods: We retrospectively analyzed the HR-VWI and clinical data of 105 patients with atherosclerotic plaques on MCA. They were divided into group 1, with the first episode of acute ischemic stroke/TIA (n=61); group 2, with recurrent acute ischemic stroke/TIA (n=19); group 3, with no occurrence of clinical event(n=25). The degree of stenosis, remodeling index and plaque features (enhancement ratio, enhancement grade, plaque burden, T1 signal intensity, and plaque distribution) were measured and compared among groups using analysis of variance, chi-square, Fisher's exact test or Mann-Whitney U test. Regression models investigated risk factors for recurrent stroke/TIA. Results: Plaque burden, enhancement ratio, remodeling index were all significantly higher in group 1 and 2, compared to group 3 (all P < 0.05). Higher plaque burden (P=0.005), higher stenosis degree (P=0.006) and more concentric plaque (P=0.008) were found in group 2 compared to group 1 (P<0.05). Multivariable logistic regression shows plaque burden was the only significant plaque marker associated with recurrent stroke/TIA (OR=1.075, 95% CI 1.019-1.133, P=0.008). Conclusion: Higher plaque burden of MCA was independently associated with recurrent acute ischemic stroke/TIA and can be an effective imaging marker for alarming the ischemic stroke recurrence.