Both extracranial and intracranial atherosclerosis may be implicated in large-artery atherothrombotic stroke. This proof-of-concept study characterized the distribution and burden of atherosclerosis in thirteen patients with anterior circulation cerebral ischemic events using combined extracranial and intracranial vessel wall MRI. We found that atherosclerotic plaques were highly prevalent in both extracranial and intracranial carotid arteries. Larger plaque burden measured as plaque index on black-blood vessel wall MRI, rather than luminal stenosis on time-of-flight MRA, was significantly associated with clinical symptoms. Black-blood vessel wall MRI may be useful in identifying the culprit plaque in patients with suspected large-artery atherothrombotic stroke.