Pre-operative recanalization assessment for acute intracranial large-vessel occlusion (LVO) can help optimize endovascular therapy and shorten procedural times. We prospectively examined 46 patients with acute intracranial LVO who underwent high-resolution magnetic resonance imaging (HRMRI) before endovascular therapy. HRMRI had good agreement with angiographic assessment of the causes of occlusion (κ=0.89, 95% CI, 0.69–1.00) and length of occlusion (concordance correlation coefficient=0.75, 95% CI, 0.59–0.86). Intraluminal enhancement was associated with procedural complexity (r=0.81, P< .001) and procedural times (r=0.64, P< .001). HRMRI before recanalization can help define the vascular status and assist with endovascular therapy of acute intracranial LVOs.