High-resolution intracranial vessel wall imaging (VWI) can provide valuable information not only regarding vascular morphology but also about the presence or absence of vessel wall enhancement; however, VWI acquisition times are often long, limiting routine use in clinical practice. We sought to investigate the use of the VWI in routine clinical practice to evaluate its application within our institution as well as optimize the imaging protocol to meet clinical needs. Our study found post-contrast VWI better demonstrated the vascular pathology compared to pre-contrast VWI. We also found only one case that may have benefited from the addition of pre-contrast VWI; however, the addition of pre-contrast VWI in this case would not have changed clinical management. Our findings suggest that the routine use pre-contrast VWI may not be needed to obtain the imaging necessary for clinical diagnosis and patient management.