Objective To investigate the predictive value of lipoprotein-associated phospholipase A2 （Lp-PLA2） in acute cerebral infarction patients with atherosclerotic stenosis of intracranial and extracranial arteries. Methods Retrospectively， a total of 1 045 patients with acute cerebral infarction who visited the Department of Neurology in Shandong Provincial Qianfoshan Hospital from May 2019 to April 2022 were selected. According to gender and location of stenosis of patients with cerebral infarction， they were divided into male non-cerebral atherosclerotic stenosis group （n=282）， male intracranial atherosclerotic stenosis group （n=265）， male extracranial atherosclerotic stenosis group （n=105）， female non-cerebral atherosclerotic stenosis group （n=173）， female intracranial atherosclerotic stenosis group （n=156）， female extracranial atherosclerotic stenosis group （n=64）. The correlation between Lp-PLA2 and symptomatic intracranial and extracranial stenosis was analyzed by multifactor Logistic regression. Results The comparison of Lp-PLA2 levels in patients with different age， gender， stroke history， coronary heart disease history， and homocysteine levels was statistically significant （P＜ 0.05）. The comparison of the number of patient cases with different Lp-PLA2 levels among male patients in the 3 groups showed a statistically significant difference （χ2 =65.276， P ＜ 0.01）. However， there was no significant differences in the comparison of the number of patient cases with different Lp-PLA2 levels among the three groups in female patients（χ2 =7.061，P＞ 0.05）. Multifactor Logistic regression analysis showed that Lp-PLA2 levels of 520.3 to 606.5 IU/L （OR=1.842， 95%CI=1.060 to 3.199， P=0.030） and ＞ 606.5 IU/L （OR=3.966， 95%CI=2.174 to 7.235， P ＜ 0.001） were risky factors for the combination of intracranial atherosclerotic stenosis in male patients with acute cerebral infarction， whereas no association was found between Lp-PLA2 and the risk of intracranial or extracranial atherosclerotic stenosis in female patients （P ＞ 0.05）. Conclusions Lp-PLA2 levels are significantly increased in male patients with acute cerebral infarction combined with intracranial atherosclerotic stenosis， and Lp-PLA2 may be used as a predictor of intracranial atherosclerotic stenosis in male patients.