Plaque characteristics of middle cerebral artery assessed using strategically acquired gradient echo (STAGE) and vessel wall MR contribute to misery downstream perfusion in patients with intracranial atherosclerosis.

• STAGE has good efficiency in evaluating MCA plaque vulnerability versus hr-vwMRI. • Higher plaque susceptibility assessed using STAGE and higher grade luminal stenosis based on hr-vwMRI attribute to misery downstream perfusion. • STAGE provides incremental value on the understanding of plaque vulnerability in addition to conventional hr-vwMRI.