The aim of this study was to investigate high risk characteristics of dissected artery using VWMRI. A total of 114 Patients with CeAD were prospectively recruited and 139 dissected vessels were analyzed. Dissected arteries in the stroke group showed a significantly higher prevalence of irregular surface, intraluminal thrombus and severe stenosis (>70%) compared with that of the non-stroke group. Logistic regression analysis showed that the presence of irregular surface and intraluminal thrombus were independently associated with ischemic stroke in CeAD. Our results provide insights into the vascular pathophysiology of symptomatic CeAD and may reveal important predictor of stroke in CeAD.