Objectives: We carried out this cross-sectional study to explore the association between cerebral large artery lesions and leukoaraiosis in Chinese patients with stroke. The relationship between leukoaraiosis and risk factors of cerebral vascular disease was also investigated. Methods: Data were prospectively collected from patients with ischemic stroke within 7 days of symptom onset. All patients underwent three-dimensional time of flight magnetic resonance angiography (MRA) and contrast-enhanced MRA for evaluating intracranial and extracranial stenosis. Leukoaraiosis grading was performed according to age-related white matter changes rating scale. Results: One hundred and eighty-five patients with acute ischemic stroke were enrolled. Of these, 121 patients (65.4%) had significant stenosis or occlusion. The frequency of distinct leukoaraiosis between the mild or no stenosis group and the significant stenosis or occlusion group was not significantly different (odd ratios: 0.97; 95% confidence interval: 0.46-2.07). In the subgroup analysis, distinct leukoaraiosis was more frequently observed in the multiple lesions group than in the single lesion group (odd ratios: 4.15; 95% confidence interval: 1.32-13.05). Age (odd ratios: 2.659; 95% confidence interval: 1.217-5.809), hypertension (odd ratios: 4.690; 95% confidence interval: 0.947-23.242), smoking (odd ratios: 4.039; 95% confidence interval: 1.340-12.174) and the level of low-density lipoprotein (odd ratios: 0.438; 95% confidence interval: 0.215-0.891) were independently associated with distinct leukoaraiosis. Conclusion: There is a lack of a relationship between cerebral large artery stenosis and leukoaraiosis, but multiple large artery stenoses may increase the risk of leukoaraiosis. [Neurol Res 2009; 31: 376-380]