Objective To analyze the characteristics of carotid plaques in patients with recurrent stroke by 3.0T high resolution magnetic resonance imaging (HR-MRI). Methods The clinical data of 68 patients with acute ischemic stroke who were admitted to the hospital from June 2015 to March 2017 were analyzed retrospectively. All patients were examined by 3.0T HR-MRI. According to the history of ischemic stroke, the patients were divided into the primary attack group (n=32) and the recurrence group (n=36). The plaque load and plaque composition were compared between the two groups. Results There was no significant difference in the area of lumen, the area and thickness of wall, total vessel area and lumen stenosis rate between the two groups (P>0.05), but the normalized wall index (NWI) of the recurrence group was significantly higher than that of the primary attackgroup (P<0.05). In terms of plaque composition, there was no significant difference between the two groups in plaque lipid necrosis core and calcification ratios (P>0.05), but the proportions of bleeding in plaque and fibrous cap rupture in the recurrence group were significantly higher than those in the primary attack group (P<0.05). Conclusion HR-MRI can effectively evaluate the characteristics of carotid artery plaques in patients with recurrent stroke, which is of great significance for the risk assessment and prevention of recurrent stroke.