<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>To investigate the characteristics of atherosclerotic plaques in stroke‐related vascular beds and their relationship with stroke using three‐dimensional magnetic resonance (<jats:styled-content style="fixed-case">MR</jats:styled-content>) vessel wall imaging.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Fifty‐two symptomatic patients (mean age: 56.3 ± 13.4 years; 38 males) were enrolled and underwent <jats:styled-content style="fixed-case">MR</jats:styled-content> vessel wall imaging for stroke‐related vascular beds including intracranial and extracranial carotid arteries and aortic arch and routine <jats:styled-content style="fixed-case">MR</jats:styled-content> imaging for brain. The maximum wall thickness (Max <jats:styled-content style="fixed-case">WT</jats:styled-content>) and luminal stenosis of each plaque were measured. The presence/absence of atherosclerotic plaque, intraplaque hemorrhage (<jats:styled-content style="fixed-case">IPH</jats:styled-content>), and severe stenosis (stenosis >50%) at each vascular bed and acute ischemic lesion (<jats:styled-content style="fixed-case">AIL</jats:styled-content>) were determined. The correlation between Max <jats:styled-content style="fixed-case">WT</jats:styled-content> of each vascular bed and <jats:styled-content style="fixed-case">AIL</jats:styled-content> was analyzed.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 52 patients, 24 (46.2%) had <jats:styled-content style="fixed-case">AIL</jats:styled-content>s, and 30 (57.7%), 34 (65.4%), and 11 (21.2%) had plaques in intracranial artery, extracranial carotid artery, and aortic arch, respectively. The prevalence of <jats:styled-content style="fixed-case">IPH</jats:styled-content> and severe stenosis was 25% and 26.9% for intracranial arteries, 13.5% and 9.6% for extracranial carotid artery, and 3.8% and 0% for aortic arch, respectively. In discriminating <jats:styled-content style="fixed-case">AIL</jats:styled-content>, Max <jats:styled-content style="fixed-case">WT</jats:styled-content> of intracranial artery had the highest area‐under‐the‐curve (<jats:styled-content style="fixed-case">AUC</jats:styled-content> = 0.84), followed by extracranial carotid artery (<jats:styled-content style="fixed-case">AUC</jats:styled-content> = 0.83) and aortic arch (<jats:styled-content style="fixed-case">AUC</jats:styled-content> = 0.78) after adjusted for confounding factors. The <jats:styled-content style="fixed-case">AUC</jats:styled-content> of Max <jats:styled-content style="fixed-case">WT</jats:styled-content> combined three stroked‐related vascular beds reached 0.87.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Extracranial carotid arteries have the highest prevalence of plaques and intraplaque hemorrhage and severe stenosis are most frequently seen in intracranial arteries in Asian symptomatic patients. The Max <jats:styled-content style="fixed-case">WT</jats:styled-content> combined three stroke‐related vascular beds show stronger predictive value for <jats:styled-content style="fixed-case">AIL</jats:styled-content> than each vascular bed alone.</jats:p></jats:sec>