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Background: The aim of this study was to investigate clinical significance of multiplicity of atherosclerotic risk factors to determine the type of stroke and long-term mortality in patients with large artery atherosclerotic (LAA) and small vessel occlusive (SVO) stroke.Methods: We retrospectively analyzed medical data of the prospectively registered stroke patients who were diagnosed as LAA and SVO type of ischemic stroke based on diffusion weighted MRI and magnetic resonance angiography between January 2005 and December 2013. Multiplicity of risk factors was defined as numbers of hypertension, diabetes, hyperlipidemia and smoking. Information on mortality as outcome was obtained and reconfirmed from the National Death Certificate system.Results: A total of 4099 patients comprising 2530 LAA stroke and 1569 SVO stroke were studied. After adjustment for differences in baseline risk profiles, multiplicity of risk factors (per 1-point increase, odds ratio [OR] = 1.10, 95% confidence interval [CI] = 1.02-1.18) was significantly associated with the LAA stroke than SVO stroke. Among patients with SVO stroke, patients with a higher multiplicity of risk factors had a higher long-term mortality (OR = 1.34, 95% CI = 1.10-1.65) during 8-year of observation.Conclusions: Atherosclerotic burden defined by multiplicity of risk factors for atherosclerosis could predict the probability of developing LAA stroke compared to the SVO stroke, and long-term mortality particularly in SVO stroke.