Objective：This study aims 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：The HR-VWI and clinical data of 105 patients with atherosclerotic plaques on MCA were retrospectively analyzed. 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 Kruskal-Wallis 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.