Objective: To determine the associations of carotid plaque characteristics by MR vessel wall imaging (MR-VWI) with NIH Stroke Scale (NIHSS) and acute cerebral infarct (ACI) lesions on diffusion weighted imaging (DWI). Materials and Methods: Patients suffered from unilateral limb symptoms (internal carotid artery territorial) with acute ischemic stroke were recruited in our study. Each patient received NIHSS in 48h, carotid MR-VWI and brain DWI+MRA in 1 week after onset of symptoms. The carotid atherosclerotic lesion variables (luminal stenosis, plaque burden and components) and corresponding ACI lesion patterns and size were analyzed to evaluate: (1) the associations of carotid plaque characteristics with NIHSS scores; (2) the correlation between symptomatic carotid plaque features and intracranial artery stenosis as well as the ACI lesion patterns; (3) the associations of carotid plaque characteristics with ACI presence and volume. Results: One hundred and fourteen patients were recruited. The main findings were as follows: (1) Carotid plaque features were insignificantly associated with NIHSS scores after adjustment for stenosis (p>0.05) ; (2) The prevalence of carotid plaque in symptomatic side was 66.7%. The patients with carotid plaque and MCA<50% stenosis more frequently presented with concomitant perforator and multiple lesions; (3) Carotid morphological measurements, such as PWV and the LRNC size were significantly associated with ipsilateral ACIs volume before and after adjustment for significant demographic factors or stenosis in patients with carotid plaque (all p<0.05). Conclusions: Carotid plaque vulnerable characteristics (high plaque burden and large LRNC) identified by MR-VWI are independently associated with cerebral infarction as measured by DWI lesions. Our findings indicate that characterizing atherosclerotic plaque by MR-VWI might be useful for stratification of plaque risk and infarction severity.