Abstract： Objective:The integrity of Willis ring and the characteristics of Atherosclerosis plaque in the skull and neck of patients with ischemic stroke in the anterior circulation were analyzed by using magnetic resonance angiography(MRA)integrated with the skull and neck to explore the image characteristics independently related to recurrent stroke.Materials and Methods:Eighty-seven patients with anterior circulation ischemic stroke were collected retrospectively.all of them were examined by high-resolution magnetic resonance angiography within 14 days after the onset of symptoms,and were divided into initial stroke group and recurrent group according to clinical and imaging data.They were divided into the initial stroke group and the recurrent stroke group based on clinical and imaging data.Record the total number of plaques,the characteristics of carotid artery plaques(intracranial:plaque enhancement,intra plaque bleeding,degree of stenosis;extracranial:lipid core,intra plaque bleeding,degree of stenosis),and the integrity of the Willis ring.Compare the characteristics of carotid artery plaques between the initial and recurrent groups.Evaluation of independent risk factors associated with recurrence of ischemic stroke in the anterior circulation using multivariate logistic regression analysis.Results:A total of 87 patients were included.There are 54 cases in the initial group and 33 cases in the recurrence group.There was no statistically significant difference in gender(P=0.223)and age(P=0.779)between the two groups.Compared with the initial group,the recurrent group showed intracranial plaque enhancement(P=0.010),degree of intracranial artery stenosis(P=0.002),total number of plaques(P＜0.001),intracranial plaque enhancement combined with extracranial plaques(P=0.006),intracranial(or extracranial)artery stenosis＞50%combined with extracranial(or intracranial)plaques(P=0.001),and incomplete symptom side of Willis'posterior circulation(P＜0.001).Significant correlation with recurrent stroke.Compared with the Willis group with intact anterior circulation,the Willis group with incomplete anterior circulation showed more enhancement of intracranial plaques(P=0.012).Multivariate logistic regression analysis showed that the total number of plaques[odds ratio(OR)=2.14,95%confidence interval(CI):1.182-3.869,P=0.012]and the incomplete symptomatic side of Willis'posterior circulation(OR=4.58,95%CI:1.496-14.041,P=0.008)were independent predictors of anterior circulation ischemic stroke recurrence.The overall prediction performance of the logistic regression model is optimal[area under the curve(AUC)=0.811,95%CI:0.711-0.910].Conclusions:The total number of plaques and incomplete posterior circulation symptoms of Willis are independently associated with the recurrence of ischemic stroke in the anterior circulation.High resolution vascular wall magnetic resonance imaging with integrated craniocervical imaging can provide new indicators for the construction of predictive models for anterior circulation ischemic stroke recurrence.