Objective To investigate the features of vessel wall in atherosclerotic stenosis of the basilar artery using high-resolution magnetic resonance vessel wall imaging （HRMR-VWI）.Methods A retrospective analysis was performed for the clinical data of 30 patients with moderate or severe （50%-99%） atherosclerotic stenosis of the basilar artery who were included in the HRMR-VWI database of Beijing Friendship Hospital， Capital Medical University， from September 2020 to December 2022， including pre- and post-contrast T1-weighted HRMR-VWI images. Vessel area （VA）， maximal wall thickness （WT）， and minimal WT were measured at the maximal lumen narrowing （MLN） sites and the reference sites. Remodeling index （RI） and eccentric index （EI） were calculated for vessel lesions， and plaque enhancement and position were assessed. The above indicators were compared between the patients with symptomatic stenosis and those with asymptomatic stenosis. Plaque distribution at MLN site and enhancement characteristics was assessed.Results A total of 27 patients were finally included for analysis， among whom there were 20 patients with symptomatic stenosis and 7 with asymptomatic stenosis. The 27 patients had an RI of 1.2±0.3 and an EI of 0.6±0.2， and significant enhancement of plaques was observed in 17 patients. Compared with the patients with asymptomatic stenosis， the patients with symptomatic stenosis had significantly higher VA， maximal WT， and RI at the MLN sites， significantly higher maximal WT at the reference sites， and a significantly higher proportion of patients with positive remodeling （P<0.05）； however， there were no significant differences between the two groups in minimal WT and EI at MLN sites and VA at the reference sites （P >0.05）. There was no significant difference in the distribution of plaques between the two groups （P>0.05）， and post-enhancement images showed no significant difference in the proportion of patients with significant plaque enhancement between the two groups （P>0.05）.Conclusions Compared with the patients with asymptomatic stenosis， the patients with symptomatic stenosis tend to have higher VA， maximal WT and RI at MLN sites， higher maximal WT at reference sites， and a higher proportion of patients with positive remodeling. These results have an important significance in assessing the risk of stroke in patients with basilar artery stenosis.