To evaluate the gender differences of local vascular and plaque characteristics in patients with symptomatic middle cerebral artery (MCA) atherosclerotic stenosis by high-resolution magnetic resonance imaging (HR-MRI). Methods: We retrospectively collected patients admitted for an ischemic event in the MCA and grouped them according to gender; within each group, the symptomatic and the asymptomatic sides were designated based on the presence or absence of ischemic signs. The local vascular and plaque characteristics acquired from HR-MRI images were compared between the groups and within the symptomatic and asymptomatic divisions of each group. Results: A total of 71 patients were eligible for inclusion and exclusion, including 46 males (64.7% ). There was a statistically significant difference in minimum lumen area between male and female patients (P=0.039), and there was a significant correlation between gender and symptomatic sides (P=0.026). There was no significant difference in the stenosis rate between male and female patients (P=0.056), but the correlation between gender and symptomatic sides of this indicator was significant (P=0.011). The male plaque load was greater (P=0.006), and the correlation between the affected sides was significant (P=0.011). Plaque enhancement was more common in males than in females (P=0.026). Multiple regression analysis suggested that the main factors affecting minimum lumen area and plaque burden were hypertension and diabetes, and gender mainly affected plaque enhancement (OR 6.75, 95% CI 1.60-28.49, P=0.009). Conclusion: There are gender differences in local vascular and plaque characteristics in patients with symptomatic MCA atherosclerosis. In male patients, the plaque volume is larger and local vascular lumen area is smaller, and vulnerable plaques are more likely to occur. Gender has no significant effect on the degree of local vascular stenosis, and ischemic events are more likely to be caused by altering the stability of local plaque.