Ischemic stroke caused by intracranial arterial stenosis (ICAS) is characterized by high morbidity and mortality. Conventional clinical examination methods include transcranial Doppler ultrasound, CT angiography, magnetic resonance angiography, and X-ray digital subtraction angiography. These methods are aimed at vascular stenosis and do not show vascular wall lesions. High-resolution magnetic resonance vessel wall imaging (HR-VWI) is a new imaging method that can non-invasively display vascular wall lesions and has important value in judging the nature of ICAS lesions. In this paper, the application of HR-VWI in the identification of ICAS etiology is reviewed.