The aim of this study was to identify relevant risk factors for occlusive lesions of the intracranial arteries in stroke-free population. The subjects of this study were 425 patients without a history of stroke or transient ischemic attack and without any abnormality on a neurological examination who consecutively visited a neurology clinic between January 1994 and June 2001 requesting medical evaluation for possible cerebrovascular diseases. Subjects included 245 men and 180 women ranging in age from 33 to 89 years (mean+/-SD=64.0+/-10.0 years). We performed cervical and intracranial magnetic resonance angiography (MRA) in all subjects. Using a validated rating scheme of MRA for occlusive lesions, we evaluated the degree of stenoses in the extracranial portion of the internal carotid artery (ICA) and the intracranial arteries including the intracranial portion of the ICA, middle cerebral artery (MCA) stem, intracranial portion of the vertebral artery (VA), and basilar artery (BA). More than 25% stenoses were regarded as significant lesions in this study. Multiple logistic regression analyses showed that significant and independent predictors for extracranial ICA lesions were age, hyperlipidemia, and ischemic heart disease (IHD), those for intracranial ICA lesions were age, hypertension, diabetes mellitus, and IHD, those for MCA lesions were age and hypertension, those for intracranial VA lesions were hyperlipidemia and IHD, and those for BA lesions were hypertension and diabetes mellitus. The present study suggested that atherosclerosis of the intracranial VA was related to hyperlipidemia and IHD as was the case for the extracranial carotid artery, whilst atherosclerosis of other sites of intracranial arteries was associated with hypertension and diabetes mellitus in stroke-free Japanese.