Atherosclerosis is characterized by chronic low-grade inflammation (LGI) of the arteries. An elevated LGI score has been associated with the onset and recurrence of cardio-cerebrovascular diseases. The aim of this multicenter hospital-based prospective cohort study was to investigate the relationship between the LGI score and stroke recurrence in patients with intracranial atherosclerotic stenosis (ICAS).Consecutive acute ischemic stroke patients admitted within 1 week after onset were screened. The intracranial arteries were evaluated via computed tomographic angiography, magnetic resonance angiography or digital subtraction angiography. Patients with ICAS were enrolled and followed up for at least 1 year. The primary outcome was ischemic stroke recurrence. Cox regression and Kaplan‒Meier survival curves were used to analyze the association of the LGI score and stroke recurrence. A total of 932 patients were divided into 4 groups according to the LGI quartiles (Q1: < 3; Q2: 3-7; Q3: 7-10; Q4: > 10). At the end of follow-up (37.37 ± 15.24 months), 80 patients experienced at least one recurrent ischemic stroke. There were significant differences in total cholesterol levels, C-reactive protein levels, white blood cell counts, platelet counts, neutrophil-to-lymphocyte ratios, and stroke recurrence among the 4 groups. According to the multivariate adjusted models, compared to that for Q1, the hazard ratio for stroke recurrence in patients in Q4 was 2.748 (1.303-5.797). The Kaplan-Meier survival (ischemic stroke-free) curves according to quartiles of the LGI score also showed significant differences (log-rank test, P = 0.016). Our findings suggested that the LGI score was an independent risk factor for ischemic stroke recurrence in patients with ICAS.