To examine whether plasma glycocalyx levels in patients with severe intracranial arterial stenosis (ICAS) are associated with the prediction of new cerebral infarctions following endovascular treatment.105 patients with ICAS who underwent endovascular treatment were enrolled from September 2020 to June 2021. Plasma glycocalyx components were detected. The condition of the cerebral artery was obtained by high-resolution nuclear magnetic resonance, and risk factors for new cerebral infarction postendovascular treatment in patients with ICAS were analyzed using both univariate and multivariate analyses. The results were presented in a nomogram risk model and evaluated.The plasma glycocalyx in patients with ICAS exhibited significant differences compared to healthy individuals (p < 0.05). Multivariate analysis revealed eccentricity (OR = 3.599, 95% CI: 1.168-12.478, p = 0.032) and hyaluronic acid (OR = 5.542, 95% CI: 1.545-23.573, p = 0.013) as risk factors (p < 0.05). The risk model encompassing eccentricity, Remodeling index, blood glucose, hyaluronic acid (HA), and age was presented as a Nomogram, with a C-index of 0.810 (95% CI, 0.729-0.890). To further analyze the risk factors affecting HA plasma concentration, the multivariate analysis showed that fibrinogen and hemoglobin A1c (HbA1C) significantly affected changes in HA.We found that HA is a critical factor in predicting adverse events of cerebral infarction after endovascular treatment in patients with ICAS. Additionally, HbA1C and fibrinogen were identified as factors influencing HA changes.ClinicalTrials.gov Identifier: NCT01994161.© 2025 The Author(s). CNS Neuroscience & Therapeutics published by John Wiley & Sons Ltd.