OBJECTIVE Our objective was to determine the distribution of intracranial atherosclerotic calcification, its association with risk factors, and cerebrovascular events in patients with major ischemic stroke. METHODS In this retrospective study, 327 patients who underwent CT scan of brain were included and the clinical parameters were recorded. Two neuroradiologists evaluated the non-contrast axial CT images for any of intracranial arteries, based on a standard CT scoring system for extent (0-4) and thickness (0-4). The composite CT score for extent and thickness of these vascular segments or vessels were recorded on all patients. RESULTS Based on of MDCT features, 155 major ischemic stroke and 172 non-ischemic stroke were enrolled The highest prevalence of calcification was seen in intracranial internal carotid artery (IICA) (73%), and less commonly in the vertebral artery (8%). There were higher prevalence of intracranial artery calcification in ischemic stroke patients than non-ischemic stroke patients (82% vs. 52%, p < 0.0001). Hypertension (OR = 1.903, 95% CI: 1.019-3.552, p < 0.05), intracranial artery calcification (OR = 2.147, 95% CI: 1.143-4.033, p < 0.05), moderate degree of calcification (OR = 2.631, 95% CI: 1.299-5.260, p < 0.05), and severe degree of calcification (OR = 3.479, 95% CI: 1.500-8.068, p < 0.05) were found to be independently associated with ischemic stroke. CONCLUSIONS Significant intracranial atherosclerosis as determined by severe CT calcification had higher incidence in ischemic stroke patients. Intracranial artery calcification with moderate and severe degree of calcification and hypertension were independently significant associated with ischemic stroke. CT calcification score might serve as an indicator of intracranial atherosclerotic disease and might be useful in predicting ischemic stroke.