Stroke is the second leading cause of death worldwide after cardiovascular disease.Recurrent ischemic stroke is usually more disabling and fatal than first stroke.Although there is a variety of models for predicting the risk of recurrent ischemic stroke,continual updates are made to enhance predictive accuracy.Notably,the integration of image biomarkers has become a critical improvement.This article provides a comprehensive review of image biomarkers associated with the recurrent ischemic stroke and evaluates their significance in predictive models,aiming is to furnish guidance for the management and prevention of ischemic stroke.