Objective To analyze the distribution of ApoE and SLCO1B1 genes in intracranial atherosclerotic stenosis in the elderly patients with cerebral infarction and investigate the relationship between the degree of arterial stenosis and blood lipids. Methods From February 2018 to February 2019,200 patients with cerebral atherosclerosis in Oriental Hospital of Beijing University of Chinese Medicine were selected, and atherosclerotic stenosis was classified according to the North American Symptomatic Carotid Endarterectomy Trial (no stenosis, mild stenosis, moderate stenosis, severe stenosis); ApoE and SLCO1B1 gene polymorphisms were detected by gene chip technology, the distribution of each gene in different degrees of intracranial artery stenosis was analyzed, and the factors affecting the occurrence of arterial stenosis in the elderly patients with cerebral infarction were summarized. SPSS 23.0 was used for statistical analysis. Data comparison between the two groups was performed using LSD-t test, χ² test or Fisher exact test depending on data type. Logistic regression analysis was used to analyze the influencing factors of atherosclerotic stenosis.Results The history of hypertension, diabetes mellitus, smoking, low-density lipoprotein cholesterol (LDL-C), ApoE, and SLCO1B1 in the cerebral infarction group were higher than those in the control group, while high-density lipoprotein cholesterol (HDL-C) was lower than in the control group (P<0.05). ApoE had the highest rate of atherosclerosis stenosis in ε4 and ε3/ε3, and the difference was significant (P<0.05). The 1b/1b stenosis rate in the combination of SLCO1B1*1b and SLCO1B1*5 genotypes was the highest, but the difference was not significant (P>0.05). With the aggravation of atherosclerotic stenosis, the concentration of total cholesterol, triglyceride, and LDL-C gradually increased, and the concentration of HDL-C gradually decreased (P<0.05). Logistic regression analysis confirmed that LDL-C, ApoE ε4, ApoE ε3/ε3 were risk factors for intracranial atherosclerotic stenosis in the elderly patients with CI. Conclusion LDL-C, ApoE ε4, ApoE ε3/ε3 are associated with intracranial atherosclerosis and stenosis, and SLCO1B1 gene and gene combination are not.