We aimed to explore whether the spatial distributions of cerebral small vessel disease (CSVD) markers were diverse in people with or without intracranial artery stenosis (ICAS).

ICAS increased the risk of lacunes by 2.99 folds (95% CI = 1.99-4.50, p < 0.001), lacunes ≥ 3 by 5.32 times (95% CI = 2.76-10.28, p < 0.001), correlated with WMH volume (β = 0.332, SE = 0.059, p < 0.001), WMH Fazekas scores ≥ 5 (OR = 4.50, 95% CI = 2.44-8.29, p < 0.001) and brain parenchymal fraction (BPF) (β = -0.012, SE = 0.002, p < 0.001), but not with CMB. ICAS associated closer with lacunes in the corresponding blood supply area. Lacunes coexist ICAS were prone in basal ganglia, while the lacunes without ICAS appeared in centrum semiovale more often. WMH with ICAS were prone to present in deep white matter involving the bilateral pyramidal tracts and superior thalamic radiation. People with ICAS were susceptible to worse cortical atrophy of right superior frontal and left rostral anterior cingulate. No obvious distributional differences were found for CMB between the two groups.

Since ICAS may involve in the upstream pathogenesis of lacunes, white matter lesion and cortical atrophy, the impact of ICAS should not be ignored when evaluating MRI markers of CSVD.