Intraplaque hemorrhage (IPH) in intracranial arteries is a possible marker of increased stroke risk. While previous studies focused on stenotic arteries, non-stenotic arteries also cause fatal stroke. We studied 100 patients using high-resolution MRI and found IPH was prevalent (>20%) in both stenotic and non-stenotic basilar arteries, and was a strong predictor of symptoms with an odd ratios of 15.4. IPH has a very high specificity (97.1%) to predict symptoms. Specifically, IPH may be useful in selecting high risk stroke patients with clinically non-significant stenosis, who may benefit from more aggressive treatment.