Objective To investigate the relationship between different lesion sites of single small subcortical infarction（ SSSI） and early neurological deterioration. Methods A total of 122 patients with SSSI admitted to the Department of Neurology of Zhongguancun Hospital of Beijing from June 2017 to June 2019 were enrolled retrospectively， and divided into proximal SSSI group（ n=52） and distal SSSI group（ n=70） according to the lesion sites. The clinical and laboratory data， imaging features， incidence of early neurological deterioration and prognosis were compared between the two groups. Multivariate logistic regression analysis was used to analyze the influencing factors of distal SSSI. Results Compared with the proximal group， the incidence of early neurological deterioration in the distal infarction group was higher［ 14.3（10/70） vs 0，χ2=8.092， P=0.005］， as well as diastolic blood pressure［ （94.14±17.29） mmHg（ 1 mmHg=0.133 kPa）vs（ 88.35±13.16） mmHg， t=-2.201， P=0.046］， diastolic blood pressure ≥ 100 mmHg［ 40.0%（ 28/70） vs 19.2%（ 10/52）， χ2=6.001，P=0.018］， triglycerol［ （1.79±1.06） mmol/L vs（ 1.39±0.78） mmol/L，t=-2.310，P=0.023］， and unstable plaque［ 68.6%（ 48/70） vs 53.8%（ 28/52），χ2=4.695，P=0.049］. All the differences were statistically significant. Unstable plaque（ OR=3.345，95%CI：1.123-9.965，P=0.030） and LDL（ OR=2.954，95%CI：1.492- 5.848，P=0.002） are independent risk factors for distal infarction. Conclusions The infarction site， clinical features and early neurological deterioration rate of SSSI patients are different. The control of hypertension， lipid metabolism disorder and the improvement of atherosclerosis by stabilizing plaque can effectively prevent the distal SSSI.