Intraplaque post-contrast enhancement (PCE) on high-resolution magnetic resonance imaging (HR-MRI) could help personalize the risk of patients with intracranial atherosclerotic disease (ICAD). We have analyzed whether plaque and wall PCE is related to endothelial damage through ECM-1 serum levels and the arterial inflammation indicated by the expression of CCR5 in a subpopulation of monocytes.We designed a prospective, longitudinal study including symptomatic ICAD patients and asymptomatic subjects with a very-high vascular risk. Study participants underwent artery-wall HR-MRI and blood sample extraction. Subjects were classified according to the presence and location of enhancement. Flow cytometry was performed to identify monocyte subpopulations (Mon1, 2, and 3) and the CCR5 expression. Inflammatory serum markers were analyzed by ELISA.We have found that a subpopulation of monocytes (Mon3CCR5+) was able to stratify the patients according to presence/absence of PCE. Mon3CCR5+ monocyte levels were lower in asymptomatic patients without PCE, increase in asymptomatic patients with PCE and was even higher in symptomatic patients. There were no differences in the inflammatory panel analyzed in serum samples apart from ECM-1 that showed a lower expression in asymptomatic patients without PCE but was increased in the patients with PCE.These findings suggest that Intracranial plaque and artery-wall PCE could be indicating an endothelial dysfunction and an increased inflammatory activity as suggested by the increase in the levels of both Mon3CCR5+ monocytes and ECM-1 serum levels.Funded by Instituto de Salud Carlos III (PI22/01625, RD21/0006/0020, RD21/0006/0005, cofounded by the European Union) and FEDER.