Objective To investigate the hemodynamic characteristics of patients with cerebral atherosclerotic stenosis and intracranial aneurysm （IA） and related risk factors.Methods Clinical data were collected from 160 patients with cerebral atherosclerotic stenosis who were treated in Suzhou Hospital of Anhui Medical University from September 2019 to January 2023. Computed tomography angiography （CTA） and digital subtraction angiography （DSA） were performed for all patients. According to the imaging findings， the patients were divided into stenosis+IA group with 25 patients and stenosis group with 135 patients. Baseline data and hemodynamic parameters were compared between the two groups. A multivariate logistic regression analysis was used to investigate the risk factors for IA in patients with cerebral atherosclerotic stenosis， and a receiver operating characteristic （ROC） curve analysis was used to assess the value of wall shear stress （WSS） and oscillatory shear index （OSI） in predicting IA in these patients.Results The stenosis+IA group had significantly higher WSS and OSI than the stenosis group （P<0.05）. Compared with the stenosis group， the stenosis+IA group had a significantly higher proportion of patients with smoking history， diabetes or hypertension （P<0.05）. The multivariate logistic regression analysis showed that smoking history， diabetes， hypertension， WSS>0.450 Pa， and OSI>0.057 were risk factors for IA in patients with cerebral atherosclerotic stenosis （P<0.05）. The ROC analysis showed that WSS and OSI could be used to predict IA in patients with cerebral atherosclerotic stenosis， with an area under the ROC curve of 0.857 and 0.784， respectively， a sensitivity of 0.681 and 0.859， respectively， and a specificity of 0.751 and 0.771， respectively （P<0.05）.Conclusions Smoking history， diabetes， hypertension， WSS>0.450 Pa， and OSI>0.057 are risk factors for IA in patients with cerebral atherosclerotic stenosis， and WSS and OSI can be used to predict IA in these patients.