Recent small subcortical infarcts (SSI) are a common radiographic predecessor to lacunar stroke. SSI is comprised of several pathophysiologic processes such as branch atherosclerotic disease (BAD) and lipohyalinosis, both of which have differing outcomes and natural history. Presently, there is not a proven method to determine whether a SSI is due to BAD or lipohyalinosis in non-stenotic vessels. However, high-resolution vessel wall imaging (HRVWI) has been reported in East Asian cohorts. We aimed to use HRVWI to identify individuals with BAD-related SSI in a North American cohort. We performed a cross-sectional study from the Rhode Island Hospital. All patients had a SSI as defined by consensus criteria. The presence of vessel wall enhancement of parent vessels were reviewed by two authors. Standard descriptive statistical techniques were used. Of 28 patients who underwent HRVWI, 7 met criteria for SSI. The median age was 68 years and 3 were female. Parent vessel wall enhancement was present in 2 patients. In our North American cohort, HRVWI was able to dichotomize individuals based on parent vessel wall enhancement suggestive of a BAD-related SSI. Further studies are needed to expand our cohort size and confirm our findings.