Factors That Influence the Occurrence of Middle Cerebral Artery Stenosis in Ischemic Stroke Patients

Factors That Influence the Occurrence of Middle Cerebral Artery Stenosis in Ischemic Stroke Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors That Influence the Occurrence of Middle Cerebral Artery Stenosis in Ischemic Stroke Patients Lisda Amalia This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8943637/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Introduction: Ischemic stroke with stenosis of the middle cerebral artery (MCA) is recognized as a critical factor associated with more severe neurological deficits and worse clinical outcomes. This study will examine the comparative characteristics and outcomes between ischemic stroke patients with and without MCA stenosis. Methods: A retrospective comparative analytic study was conducted using medical records of ischemic stroke patients who underwent Transcranial Doppler (TCD) examination. Patients were divided into two groups: with and without MCA stenosis. Statistical significance calculated with Mann-Whitney test, ANOVA, and multiple logistic regression. Results: There were 206 patients included in this study, divided into 103 patients with intracranial stenosis and 103 patients with non-intracranial stenosis. Patients with MCA stenosis were predominantly older than 45 years (p = 0.043) and had history of hypertension, dyslipidemia, diabetes mellitus, and smoking history (p = 0.012; p = 0.005; p = 0.016; and p = 0.048, respectively). Decreased level of consciousness (p = 0.045), language impairment (p = 0.001), visual impairment (p = 0.005), and balance impairment (p = 0.009) were more frequent in the stenosis group. A lower ASPECTS score (≤ 7) was significantly more common (p < 0.001), and both admission and discharge NIHSS scores indicated greater neurological severity in patients with stenosis (p < 0.001). From logistic regression, we found that older age, hypertension, hyperlipidemia, smoking, Diabetes Mellitus, aphasia, decrease level of consciousness, balance disorder, visual disturbance, and lower ASPECT, was statistically significance correlate with intracranial stenosis (p < 0.05). Conclusion: Older age, hypertension, hyperlipidemia, smoking, Diabetes Mellitus, aphasia, decrease level of consciousness, balance disorder, visual disturbance, and lower ASPECT plays a role in the occurrence of MCA stenosis in acute ischemic stroke patients. The modality used to assess MCA stenosis in this study was limited to Transcranial Doppler (TCD), without confirmation by other imaging techniques. ischemic stroke middle cerebral artery stenosis risk factors ASPECTS NIHSS clinical outcome Figures Figure 1 INTRODUCTION According to the World Health Organization, a stroke is defined as a sudden neurological deficit, which can be either focal or global, and it involves symptoms that last for less than 24 hours or longer, potentially leading to death. The cause of the stroke must be related to a disorder of the vascular system. Stroke is the second most common cause of death globally, following ischemic heart disease, and it is also the third leading cause of disability after ischemic heart disease. In up to 45% to 62% of individuals who experience an ischemic stroke, plaque or stenosis is found, and these conditions are responsible for 10% to 20% of all such cases. 1 , 2 Intracranial atherosclerotic disease (ICAD) is thought to affect between 10% and 65% of Asian individuals, and it is responsible for 30% to 50% of all ischemic strokes. 3 In Asian communities, narrowing of the intracranial arteries is more prevalent compared to narrowing of the extracranial arteries, with the Middle Cerebral Artery (MCA) being the most commonly affected blood vessel. 4 Patients who experience an ischemic stroke due to narrowing of the middle cerebral artery (MCA) often face more serious neurological issues at the time of the stroke, along with a higher likelihood of having another stroke, worse overall recovery, and a greater risk of death within three months after the stroke. 5 Patients who have severe (> 70%) intracranial atherosclerotic disease are at the greatest risk of experiencing another stroke that will affect patient outcomes. Transcranial Doppler (TCD) has proven to be highly accurate in detecting intracranial arterial stenosis or occlusion in patients with acute ischemic stroke, especially MCA when performed shortly after computed tomography angiography (CTA). 5 , 34 This study will assess what factors can influence the incidence of MCA stenosis so that appropriate prevention and management can be carried out to improve the clinical outcomes of ischemic stroke patients with MCA stenosis. METHODS This is a comparative analytical study with a retrospective approach using medical records of patients diagnosed with ischemic stroke in the Neurology Department of Dr. Hasan Sadikin General Hospital, Bandung, from 2023 to 2024. Sampling was conducted using a purposive sampling method, with the minimum sample size calculated using an unpaired categorical comparative analytical formula. Inclusion criteria included medical records of patients with ischemic stroke confirmed by a non-contrast head CT scan, who had undergone a transcranial Doppler examination, and were treated in the Neurology Ward of Dr. Hasan Sadikin General Hospital, Bandung. Exclusion criteria included incomplete, missing, or inaccessible medical records of patients with ischemic stroke. Data were analyzed using SPSS software. Prior to the comparative analysis, a normality test was performed to determine data distribution. Statistical significance calculated with Mann-Whitney test, ANOVA, and multiple logistic regression, with the significance level set at p < 0.05. RESULTS This study analyzed 206 medical records of ischemic stroke patients, consisting of 103 patients with middle cerebral artery stenosis and 103 patients without stenosis. The research subject recruitment process is listed in Fig. 1 . Based on demographic characteristics in Table 1 , there was a significant difference in age distribution, with patients aged > 45 years being more common in the group with stenosis (91.3%) than in the group without stenosis (81.6%) (p = 0.043). However, there was no significant difference in gender distribution between the two groups (p = 0.210). Table 1 Comparison of clinical characteristic research subject with and without stenosis *statistically significant Characteristic Stenosis Without Stenosis P-value Amount (n) Percentage (%) Amount (n) Percentage (%) Age ≤ 45 year 9 8.7% 19 18.4% 0.043* > 45 year 94 91.3% 84 81.6% Gender Male 60 58.3% 51 49.5% 0.210 Female 43 41.7% 52 50.5% Risk factors Hypertension 98 95.1% 87 84.5% 0.012* Diabetes Mellitus 37 35.9% 19 18.4% 0.005* Dyslipidemia 89 86.4% 75 72.8% 0.016* Obesity 3 2.9% 2 1.9% 0.652 Smoking 49 47.6% 35 34% 0.048* Sign and symptoms on admission Decrease level conciousness 29 28.2% 17 16.5% 0.045* Sensory problem 17 16.5% 10 9.7% 0.149 Aphasia 15 14.6% 2 1.9% 0.001* Visual problem 1 1.0% 10 9.7% 0.005* Balance disorder 6 5.8% 18 17.5% 0.009* Headache 12 11.7% 10 9.7% 0.653 Hemiparesis 95 92.2% 86 83.5% 0.055 ASPECTS score ≤ 7 87 84.5% 10 9.7% 7 16 15.5% 93 90.3% NIHSS on admission Mild (1–4) 4 3.9% 52 50.5% < 0.001* Moderate (5–15) 97 94.2% 51 49.5% Moderate to Severe (16–20) 2 1.9% 0 0.0% Severe to very severe (21–42) 0 0.0% 0 0.0% NIHSS on discharge Mild (1–4) 21 20.4% 93 90.3% < 0.001* Moderate (5–15) 80 77.7% 10 9.7% Moderate to Severe (16–20) 2 1.9% 0 0.0% Severe to very severe (21–42) 0 0.0% 0 0.0% Clinical outcome Dead 1 1.0% 0 0.0% 0.317 Alive 102 99.0% 103 100% Risk factor analysis revealed that the group with stenosis had a higher proportion of hypertension (95.1%), diabetes mellitus (35.9%), dyslipidemia (86.4%), and smoking history (47.6%) than the group without stenosis (p = 0.012; p = 0.005; p = 0.016; and p = 0.048, respectively). Meanwhile, obesity did not show a significant difference between the two groups (p = 0.652). Based on signs and symptoms at presentation, several variables showed significant differences. Decreased level of consciousness (p = 0.045), language impairment (p = 0.001), visual impairment (p = 0.005), and balance impairment (p = 0.009) were statistically different between the two groups, with a higher proportion in the stenosis group. In contrast, sensory impairment (p = 0.149), headache (p = 0.653), and motor weakness (p = 0.055) did not show significant differences. There was a highly significant difference in ASPECTS scores between the two groups (p 7 (15.5%). Conversely, in the group without stenosis, the majority of patients had an ASPECTS score > 7 (90.3%), with a lower number of patients with a score ≤ 7 (9.7%). NIHSS scores on admission showed a higher incidence of mild strokes (50.5%) in the group without stenosis, while the stenosis group experienced a higher incidence of moderate strokes (94.2%) and moderate to severe strokes (1.9%), with a statistically significant difference (p < 0.001). At the discharge NIHSS scores, the majority of patients in the group without stenosis improved to the mild stroke category (90.3%), while the majority of patients in the stenosis group remained in the moderate stroke category (77.7%). This result also demonstrated a statistically significant difference (p < 0.001). Clinical outcomes showed that only one patient in the group with stenosis died, while all patients in the group without stenosis survived. However, this difference did not reach statistical significance (p = 0.317). From logistic regression analysis, we found that older age, hypertension, hyperlipidemia, smoking, Diabetes Mellitus, aphasia, decreased level of consciousness, balance disorder, visual disturbance, and lower ASPECT were statistically significant correlates with intracranial stenosis (p < 0.05) (Table 2 ). This indicates that older age, hypertension, hyperlipidemia, smoking, Diabetes Mellitus, aphasia, decreased level of consciousness, balance disorder, visual disturbance, and lower ASPECT play a role in the occurrence of intracranial stenosis in patients with acute ischemic stroke. Table 2 Regression Logistics of Acute Ischemic Stroke with Intracranial Stenosis Variable Standard error Odds ratio 95% CI p-value Age 0.033 4.064 0.749–0.881 0.045* Hypertension 0.029 6.437 0.786–0.902 0.011* Diabetes Mellitus 0.043 7.612 0.099–0.269 0.006* Hyperlipidemia 0.039 5.804 0.650–0.805 0.016* Smoking 0.489 4.233 0.244–0.434 0.04* ASPECT score 0.187 7.346 7.232–7.971 0.007* NIHSS on admission 0.173 1.760 5.006–5.692 0.186 NIHSS on discharge 0.036 1.537 0.0243–0.169 0.152 Visual disturbances 0.021 7.910 0.0539-0.140 0.005* Aphasia 0.026 11.487 -0.0329- 0.071 0.0008* Balance disorders 0.031 6.820 0.113–0.236 0.009* Decreased level of conciousness 0.040 4.234 0.084–0.245 0.04* *statistically significant DISCUSSION This study examined the characteristics and clinical outcomes of ischemic stroke patients who either had or did not have middle cerebral artery stenosis at Dr. Hasan Sadikin General Hospital in Bandung. The analysis included 206 patients, and it was found that there were statistically significant differences between the two groups in several key variables. These included age, risk factors, specific neurological symptoms, and the severity of the stroke, which was assessed using the NIHSS score. 11 , 12 This study found that the group with middle cerebral artery stenosis was predominantly individuals aged 45 years and older (91.3%), while the group without stenosis had a lower percentage (81.6%), with a statistically significant difference (p = 0.043). This finding aligns with previous studies showing that ischemic stroke with middle cerebral artery stenosis is more common in older adults. 5 , 6 Other studies have shown that the risk of intracranial arterial stenosis, including middle cerebral artery stenosis due to large-vessel atherosclerosis, increases with age. 7 – 9 With aging, vascular changes occur, such as increased arterial stiffness and pulse pressure, which can affect cerebral hemodynamics. 11 This condition can increase pulsatility in the middle cerebral artery and contribute to an increased risk of stenosis and ischemic stroke. 10 The analysis of risk factors in this study revealed that the group with stenosis had a higher proportion of most risk factors associated with ischemic stroke, such as hypertension, dyslipidemia, diabetes mellitus, and a history of smoking. Hypertension was identified as the most significant risk factor in the stenosis group, with 95.1% of individuals having a history of hypertension, compared to 84.5% in the group without stenosis (p = 0.012). This result aligns with earlier research that has shown a higher prevalence of intracranial stenosis, including in the middle cerebral artery, among patients with a history of hypertension. 5 , 6 , 13 , 14 Chronic hypertension accelerates the formation of atherosclerotic plaques that cause narrowing and stiffness of the arteries, and disrupts cerebral autoregulation mechanisms that increase the vulnerability of cerebral blood vessels to damage and increase the risk of stenosis. 9 The incidence of dyslipidemia was found to be more frequent in the group with stenosis (86.4%) compared to the group without stenosis (72.8%) (p = 0.016). Previous research has also indicated that dyslipidemia is more frequently observed in patients who have middle cerebral artery stenosis. 5 , 6 , 15 Lipid metabolism disorders are known to play an important role in the development of atherosclerosis, especially those related to levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL), and total cholesterol. The buildup of lipids in the walls of blood vessels can lead to thickening of the intima layer in cerebral arteries. 16 In this study, Diabetes mellitus (DM) was observed more often in the stenosis group, with a prevalence of 35.9%, compared to 17.5% in the other group (p = 0.05). These findings align with previous research conducted by Jeng et al. and Xu et al., who also noted a higher incidence of DM among patients diagnosed with middle cerebral artery stenosis. 17 DM is associated with increased oxidative stress due to high levels of free radicals and low levels of antioxidants that cause endothelial dysfunction and activation of the inflammatory process, thus accelerating the formation of atherosclerotic lesions in blood vessels. 18 A history of smoking was more common in the stenosis group, with 47.6% of patients having a smoking history, compared to a lower percentage in the group without stenosis (p = 0.048). This trend was also observed in the studies conducted by Jeng et al., Ojha et al., and Telman et al., who reported that individuals with stenosis were more likely to have a history of smoking. 5 , 6 , 19 The underlying mechanism involves exposure to toxic substances in cigarettes that damage blood vessels through inflammation and endothelial dysfunction, thus causing impaired vasodilation and increasing the tendency for thrombosis and atherosclerosis. 20 , 21 In this study, the group with stenosis had a higher occurrence of symptoms related to decreased consciousness (28.2%; p = 0.045) and language disorders (14.6%; p = 0.001). This finding is supported by case reports that middle cerebral artery stenosis can cause decreased consciousness due to cerebral hypoperfusion. 22 Studies show that the majority of left hemisphere stroke patients experience language and speech disorders, indicating that middle cerebral artery stenosis plays a role in the development of aphasia. 23 This is due to the fact that the middle cerebral artery supplies Broca's and Wernicke's areas, which play a key role in language production and understanding. Meanwhile, symptoms such as visual disturbances were observed in 9.7% of cases (p = 0.005) and balance disorders in 17.5% of cases (p = 0.009), both of which were more common in the group that did not have stenosis. These results are likely related to the location of the infarction, which is not directly related to the distribution of the middle cerebral artery, such as the vertebrobasilar circulation that supplies the brainstem and cerebellum. 27 , 28 Strokes in this area generally cause typical symptoms such as vertigo, ataxia, diplopia, and nystagmus. 25 , 26 The Alberta Stroke Program Early CT Score (ASPECTS) is a tool that uses head CT scans to measure the amount of brain tissue damage caused by an ischemic stroke. When analyzing the ASPECTS scores, there were notable differences between patients who had stenosis and those who did not. Most patients in the stenosis group had an ASPECTS score of 7 or lower (84.5%), whereas the majority of patients without stenosis had a score higher than 7 (90.3%; p < 0.05). 29 A study examining ischemic stroke patients with large atherosclerotic subtypes, such as middle cerebral artery stenosis, found that individuals with this particular subtype were more likely to have ASPECTS scores of 7 or lower. 30 The ASPECTS score is also known to correlate with the NIHSS score, where low ASPECTS scores in ischemic stroke tend to be accompanied by high NIHSS scores, and vice versa. 30 , 31 In the group without stenosis, the arrival NIHSS score indicated that some patients were in the mild stroke category (50.5%), while others were in the moderate stroke category (49.5%), and no patients with moderate to severe or severe strokes were found. The discharge NIHSS score in this group showed that the majority of patients improved to the mild stroke category (90.3%), with only a small proportion remaining in the moderate category (20.4%), and no patients with severe strokes. These findings indicate that ischemic stroke patients without stenosis have good potential for neurological improvement. The absence of blood vessel obstructions such as stenosis allows for optimal brain tissue reperfusion, thus supporting nerve tissue regeneration and reducing the severity of neurological deficits. 32 Conversely, in the group with stenosis, stroke severity appeared higher. The variation in the distribution of stroke severity, as indicated by the admission and discharge NIHSS scores, showed a statistically significant difference between the two groups (p < 0.001). This finding supports the hypothesis that the presence of stenosis has an impact on the severity and clinical outcomes of ischemic stroke. This result aligns with previous research conducted by Jeng et al. and Xu et al., who found that patients with middle cerebral artery (MCA) stenosis had higher NIHSS scores upon admission and experienced worse clinical outcomes compared to those without stenosis. 5 , 17 Middle cerebral artery stenosis can cause ischemia in various important areas of the brain, such as the insula, basal ganglia, and the cortex of the frontal, temporal, and parietal lobes. 3 , 29 Furthermore, stenosis also has the potential to trigger hemodynamic instability and increase the risk of stroke-in-evolution, where neurological deficits progressively worsen due to decreased perfusion. 5 In cases of severe stenosis, collateral flow limitation also increases the size of the infarct core, decreases the ASPECTS score, and further worsens the clinical severity assessed by NIHSS. 33 Patients with stenosis in this study demonstrated a more severe clinical profile, characterized by lower ASPECTS scores and higher NIHSS scores on both admission and discharge. These findings indicate that the presence of middle cerebral artery stenosis is linked to more extensive damage to brain tissue and a higher level of neurological severity, which could theoretically lead to poorer outcomes, such as increased mortality. These results also align with earlier studies that have shown patients with middle cerebral artery stenosis are at a greater risk of facing complications and experiencing higher rates of death. 5 Thus, although statistically the difference in mortality in this study was not significant, the presence of one case of death in the stenosis group still reflects a tendency for poor outcomes and it should be considered in the prediction assessment for patients who have had an ischemic stroke and have narrowing in the middle cerebral artery. 5 Limitation of Study This study has several limitations that should be considered when interpreting the results. The retrospective design, using secondary data from medical records, makes researchers highly dependent on the completeness and accuracy of previous data, which can introduce potential bias. Clinical outcome assessments only used NIHSS and ASPECTS scores without long-term functional evaluations such as the modified Rankin Scale (mRS), thus not fully reflecting the level of disability in post-stroke patients. Furthermore, several factors that may influence the recovery process, such as comorbidities, lifestyle, medication adherence, and access to rehabilitation, have not been further analyzed. The modality used to assess stenosis in this study was limited to Transcranial Doppler (TCD), without confirmation by other imaging techniques such as CT angiography, MR angiography, or Digital Subtraction Angiography (DSA). Another limitation of this study is that the data came from only one institution, so there may be differences in characteristics from other institutions. Future research could include multicenter studies to more comprehensively assess the risk factors for MCA stenosis. CONCLUSION Older age, hypertension, hyperlipidemia, smoking, Diabetes Mellitus, aphasia, decrease level of consciousness, balance disorder, visual disturbance, and lower ASPECT plays a role in the occurrence of MCA stenosis in acute ischemic stroke patients. Declarations Ethical Approval This research has received ethical approval from the Research Ethics Committee of Padjadjaran University, as documented in decree number 327/UN6.KEP/EC/2025. Additionally, the research has been granted permission to carry out the study and collect data from the Hasan Sadikin Hospital Ministry of Health, with reference number DP.04.03/D.XIV.4.4/1499/2025. The study adhered to all applicable ethical guidelines, including the Declaration of Helsinki. Each participant was fully informed about the Informed Consent All participants provided informed and written consent prior to their involvement in the study. Competing Interests The author confirms that there are no known competing financial interests or personal relationships that could have influenced the findings or conclusions presented in this paper. Funding No funding Author Contribution LA: made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published Data Availability The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. References Gorelick PB, Wong KS, Bae HJ, Pandey DK. 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Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 16 Apr, 2026 Reviewers agreed at journal 03 Apr, 2026 Reviewers agreed at journal 25 Mar, 2026 Reviewers invited by journal 25 Mar, 2026 Editor invited by journal 03 Mar, 2026 Editor assigned by journal 02 Mar, 2026 Submission checks completed at journal 02 Mar, 2026 First submitted to journal 23 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8943637","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":611847640,"identity":"2b4163cb-af12-401e-be93-edade2204faa","order_by":0,"name":"Lisda Amalia","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBACPmYGBgmGCjDbAETwMBwgoIUNrOUMSVqAWIKxDaGFgbAWdvaHN37OO5xnzn54A8OPGgYZPsIO4zG27N12uNiyJ62AsecYA48kEVrYJHi3HU7ccCDHgIG3gYHHgLAW9meSf+cAtZx/Y8D4lzgtDGbSvA1ALTdyDJiJtIXH2FrmWHrizhnPCg7LHJMg7Bd+/uMPb76psU7czp+88eGbGht7giEGB6BIOQCKVuKBAQlqR8EoGAWjYIQBACuEO5X8+ZdeAAAAAElFTkSuQmCC","orcid":"","institution":"Padjadjaran University","correspondingAuthor":true,"prefix":"","firstName":"Lisda","middleName":"","lastName":"Amalia","suffix":""}],"badges":[],"createdAt":"2026-02-23 06:38:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8943637/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8943637/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105571760,"identity":"ab28b562-b28f-4ac1-90b4-dd6d3c54e0b2","added_by":"auto","created_at":"2026-03-27 13:24:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30930,"visible":true,"origin":"","legend":"\u003cp\u003eResearch subject flow recruitment\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8943637/v1/6c70ec7c3b8e88f37bd8a83f.png"},{"id":105903902,"identity":"50968dcf-36d3-495c-ad3a-165b8a572cde","added_by":"auto","created_at":"2026-04-01 09:57:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":666026,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8943637/v1/c275fc05-3f3e-4e64-87d8-b9bf96cc1333.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFactors That Influence the Occurrence of Middle Cerebral Artery Stenosis in Ischemic Stroke Patients\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAccording to the World Health Organization, a stroke is defined as a sudden neurological deficit, which can be either focal or global, and it involves symptoms that last for less than 24 hours or longer, potentially leading to death. The cause of the stroke must be related to a disorder of the vascular system. Stroke is the second most common cause of death globally, following ischemic heart disease, and it is also the third leading cause of disability after ischemic heart disease. In up to 45% to 62% of individuals who experience an ischemic stroke, plaque or stenosis is found, and these conditions are responsible for 10% to 20% of all such cases.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Intracranial atherosclerotic disease (ICAD) is thought to affect between 10% and 65% of Asian individuals, and it is responsible for 30% to 50% of all ischemic strokes.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e In Asian communities, narrowing of the intracranial arteries is more prevalent compared to narrowing of the extracranial arteries, with the Middle Cerebral Artery (MCA) being the most commonly affected blood vessel.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Patients who experience an ischemic stroke due to narrowing of the middle cerebral artery (MCA) often face more serious neurological issues at the time of the stroke, along with a higher likelihood of having another stroke, worse overall recovery, and a greater risk of death within three months after the stroke.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Patients who have severe (\u0026gt;\u0026thinsp;70%) intracranial atherosclerotic disease are at the greatest risk of experiencing another stroke that will affect patient outcomes. Transcranial Doppler (TCD) has proven to be highly accurate in detecting intracranial arterial stenosis or occlusion in patients with acute ischemic stroke, especially MCA when performed shortly after computed tomography angiography (CTA).\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study will assess what factors can influence the incidence of MCA stenosis so that appropriate prevention and management can be carried out to improve the clinical outcomes of ischemic stroke patients with MCA stenosis.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis is a comparative analytical study with a retrospective approach using medical records of patients diagnosed with ischemic stroke\u003c/p\u003e \u003cp\u003ein the Neurology Department of Dr. Hasan Sadikin General Hospital, Bandung, from 2023 to 2024.\u003c/p\u003e \u003cp\u003eSampling was conducted using a purposive sampling method, with the minimum sample size calculated using an unpaired categorical comparative analytical formula. Inclusion criteria included medical records of patients with ischemic stroke confirmed by a non-contrast head CT scan, who had undergone a transcranial Doppler examination, and were treated in the Neurology Ward of Dr. Hasan Sadikin General Hospital, Bandung. Exclusion criteria included incomplete, missing, or inaccessible medical records of patients with ischemic stroke.\u003c/p\u003e \u003cp\u003eData were analyzed using SPSS software. Prior to the comparative analysis, a normality test was performed to determine data distribution. Statistical significance calculated with Mann-Whitney test, ANOVA, and multiple logistic regression, with the significance level set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThis study analyzed 206 medical records of ischemic stroke patients, consisting of 103 patients with middle cerebral artery stenosis and 103 patients without stenosis. The research subject recruitment process is listed in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBased on demographic characteristics in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, there was a significant difference in age distribution, with patients aged\u0026thinsp;\u0026gt;\u0026thinsp;45 years being more common in the group with stenosis (91.3%) than in the group without stenosis (81.6%) (p\u0026thinsp;=\u0026thinsp;0.043). However, there was no significant difference in gender distribution between the two groups (p\u0026thinsp;=\u0026thinsp;0.210).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of clinical characteristic research subject with and without stenosis *statistically significant\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eStenosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eWithout Stenosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmount (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAmount\u003c/p\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le; 45 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.043*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 45 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRisk factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.012*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.016*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.652\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.048*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSign and symptoms on admission\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecrease level conciousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.045*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSensory problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAphasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisual problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBalance disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.009*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeadache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.653\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemiparesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e83.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eASPECTS score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le; 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNIHSS on admission\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild (1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate (5\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate to Severe (16\u0026ndash;20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere to very severe (21\u0026ndash;42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNIHSS on discharge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild (1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate (5\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate to Severe (16\u0026ndash;20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere to very severe (21\u0026ndash;42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical outcome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDead\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.317\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRisk factor analysis revealed that the group with stenosis had a higher proportion of hypertension (95.1%), diabetes mellitus (35.9%), dyslipidemia (86.4%), and smoking history (47.6%) than the group without stenosis (p\u0026thinsp;=\u0026thinsp;0.012; p\u0026thinsp;=\u0026thinsp;0.005; p\u0026thinsp;=\u0026thinsp;0.016; and p\u0026thinsp;=\u0026thinsp;0.048, respectively). Meanwhile, obesity did not show a significant difference between the two groups (p\u0026thinsp;=\u0026thinsp;0.652).\u003c/p\u003e \u003cp\u003eBased on signs and symptoms at presentation, several variables showed significant differences. Decreased level of consciousness (p\u0026thinsp;=\u0026thinsp;0.045), language impairment (p\u0026thinsp;=\u0026thinsp;0.001), visual impairment (p\u0026thinsp;=\u0026thinsp;0.005), and balance impairment (p\u0026thinsp;=\u0026thinsp;0.009) were statistically different between the two groups, with a higher proportion in the stenosis group. In contrast, sensory impairment (p\u0026thinsp;=\u0026thinsp;0.149), headache (p\u0026thinsp;=\u0026thinsp;0.653), and motor weakness (p\u0026thinsp;=\u0026thinsp;0.055) did not show significant differences.\u003c/p\u003e \u003cp\u003eThere was a highly significant difference in ASPECTS scores between the two groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the group with stenosis, most patients had an ASPECTS score\u0026thinsp;\u0026le;\u0026thinsp;7 (84.5%), while only a small number of patients had a score\u0026thinsp;\u0026gt;\u0026thinsp;7 (15.5%). Conversely, in the group without stenosis, the majority of patients had an ASPECTS score\u0026thinsp;\u0026gt;\u0026thinsp;7 (90.3%), with a lower number of patients with a score\u0026thinsp;\u0026le;\u0026thinsp;7 (9.7%). NIHSS scores on admission showed a higher incidence of mild strokes (50.5%) in the group without stenosis, while the stenosis group experienced a higher incidence of moderate strokes (94.2%) and moderate to severe strokes (1.9%), with a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). At the discharge NIHSS scores, the majority of patients in the group without stenosis improved to the mild stroke category (90.3%), while the majority of patients in the stenosis group remained in the moderate stroke category (77.7%). This result also demonstrated a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Clinical outcomes showed that only one patient in the group with stenosis died, while all patients in the group without stenosis survived. However, this difference did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.317).\u003c/p\u003e \u003cp\u003eFrom logistic regression analysis, we found that older age, hypertension, hyperlipidemia, smoking, Diabetes Mellitus, aphasia, decreased level of consciousness, balance disorder, visual disturbance, and lower ASPECT were statistically significant correlates with intracranial stenosis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This indicates that older age, hypertension, hyperlipidemia, smoking, Diabetes Mellitus, aphasia, decreased level of consciousness, balance disorder, visual disturbance, and lower ASPECT play a role in the occurrence of intracranial stenosis in patients with acute ischemic stroke.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRegression Logistics of Acute Ischemic Stroke with Intracranial Stenosis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStandard error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.749\u0026ndash;0.881\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.045*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.786\u0026ndash;0.902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.011*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.099\u0026ndash;0.269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.006*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.650\u0026ndash;0.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.016*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.244\u0026ndash;0.434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASPECT score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.232\u0026ndash;7.971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.007*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNIHSS on admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.760\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.006\u0026ndash;5.692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNIHSS on discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0243\u0026ndash;0.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisual disturbances\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.910\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0539-0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAphasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.0329- 0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0008*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBalance disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.113\u0026ndash;0.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.009*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecreased level of conciousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.084\u0026ndash;0.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study examined the characteristics and clinical outcomes of ischemic stroke patients who either had or did not have middle cerebral artery stenosis at Dr. Hasan Sadikin General Hospital in Bandung. The analysis included 206 patients, and it was found that there were statistically significant differences between the two groups in several key variables. These included age, risk factors, specific neurological symptoms, and the severity of the stroke, which was assessed using the NIHSS score.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e This study found that the group with middle cerebral artery stenosis was predominantly individuals aged 45 years and older (91.3%), while the group without stenosis had a lower percentage (81.6%), with a statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.043). This finding aligns with previous studies showing that ischemic stroke with middle cerebral artery stenosis is more common in older adults.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Other studies have shown that the risk of intracranial arterial stenosis, including middle cerebral artery stenosis due to large-vessel atherosclerosis, increases with age.\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e With aging, vascular changes occur, such as increased arterial stiffness and pulse pressure, which can affect cerebral hemodynamics.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e This condition can increase pulsatility in the middle cerebral artery and contribute to an increased risk of stenosis and ischemic stroke.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe analysis of risk factors in this study revealed that the group with stenosis had a higher proportion of most risk factors associated with ischemic stroke, such as hypertension, dyslipidemia, diabetes mellitus, and a history of smoking.\u003c/p\u003e \u003cp\u003eHypertension was identified as the most significant risk factor in the stenosis group, with 95.1% of individuals having a history of hypertension, compared to 84.5% in the group without stenosis (p\u0026thinsp;=\u0026thinsp;0.012). This result aligns with earlier research that has shown a higher prevalence of intracranial stenosis, including in the middle cerebral artery, among patients with a history of hypertension.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Chronic hypertension accelerates the formation of atherosclerotic plaques that cause narrowing and stiffness of the arteries, and disrupts cerebral autoregulation mechanisms that increase the vulnerability of cerebral blood vessels to damage and increase the risk of stenosis.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe incidence of dyslipidemia was found to be more frequent in the group with stenosis (86.4%) compared to the group without stenosis (72.8%) (p\u0026thinsp;=\u0026thinsp;0.016). Previous research has also indicated that dyslipidemia is more frequently observed in patients who have middle cerebral artery stenosis.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Lipid metabolism disorders are known to play an important role in the development of atherosclerosis, especially those related to levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL), and total cholesterol. The buildup of lipids in the walls of blood vessels can lead to thickening of the intima layer in cerebral arteries.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn this study, Diabetes mellitus (DM) was observed more often in the stenosis group, with a prevalence of 35.9%, compared to 17.5% in the other group (p\u0026thinsp;=\u0026thinsp;0.05). These findings align with previous research conducted by Jeng et al. and Xu et al., who also noted a higher incidence of DM among patients diagnosed with middle cerebral artery stenosis.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e DM is associated with increased oxidative stress due to high levels of free radicals and low levels of antioxidants that cause endothelial dysfunction and activation of the inflammatory process, thus accelerating the formation of atherosclerotic lesions in blood vessels.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA history of smoking was more common in the stenosis group, with 47.6% of patients having a smoking history, compared to a lower percentage in the group without stenosis (p\u0026thinsp;=\u0026thinsp;0.048). This trend was also observed in the studies conducted by Jeng et al., Ojha et al., and Telman et al., who reported that individuals with stenosis were more likely to have a history of smoking.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e The underlying mechanism involves exposure to toxic substances in cigarettes that damage blood vessels through inflammation and endothelial dysfunction, thus causing impaired vasodilation and increasing the tendency for thrombosis and atherosclerosis.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn this study, the group with stenosis had a higher occurrence of symptoms related to decreased consciousness (28.2%; p\u0026thinsp;=\u0026thinsp;0.045) and language disorders (14.6%; p\u0026thinsp;=\u0026thinsp;0.001). This finding is supported by case reports that middle cerebral artery stenosis can cause decreased consciousness due to cerebral hypoperfusion.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Studies show that the majority of left hemisphere stroke patients experience language and speech disorders, indicating that middle cerebral artery stenosis plays a role in the development of aphasia.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e This is due to the fact that the middle cerebral artery supplies Broca's and Wernicke's areas, which play a key role in language production and understanding.\u003c/p\u003e \u003cp\u003eMeanwhile, symptoms such as visual disturbances were observed in 9.7% of cases (p\u0026thinsp;=\u0026thinsp;0.005) and balance disorders in 17.5% of cases (p\u0026thinsp;=\u0026thinsp;0.009), both of which were more common in the group that did not have stenosis. These results are likely related to the location of the infarction, which is not directly related to the distribution of the middle cerebral artery, such as the vertebrobasilar circulation that supplies the brainstem and cerebellum.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Strokes in this area generally cause typical symptoms such as vertigo, ataxia, diplopia, and nystagmus.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe Alberta Stroke Program Early CT Score (ASPECTS) is a tool that uses head CT scans to measure the amount of brain tissue damage caused by an ischemic stroke. When analyzing the ASPECTS scores, there were notable differences between patients who had stenosis and those who did not. Most patients in the stenosis group had an ASPECTS score of 7 or lower (84.5%), whereas the majority of patients without stenosis had a score higher than 7 (90.3%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003csup\u003e29\u003c/sup\u003e A study examining ischemic stroke patients with large atherosclerotic subtypes, such as middle cerebral artery stenosis, found that individuals with this particular subtype were more likely to have ASPECTS scores of 7 or lower.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e The ASPECTS score is also known to correlate with the NIHSS score, where low ASPECTS scores in ischemic stroke tend to be accompanied by high NIHSS scores, and vice versa.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e In the group without stenosis, the arrival NIHSS score indicated that some patients were in the mild stroke category (50.5%), while others were in the moderate stroke category (49.5%), and no patients with moderate to severe or severe strokes were found. The discharge NIHSS score in this group showed that the majority of patients improved to the mild stroke category (90.3%), with only a small proportion remaining in the moderate category (20.4%), and no patients with severe strokes. These findings indicate that ischemic stroke patients without stenosis have good potential for neurological improvement. The absence of blood vessel obstructions such as stenosis allows for optimal brain tissue reperfusion, thus supporting nerve tissue regeneration and reducing the severity of neurological deficits.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e Conversely, in the group with stenosis, stroke severity appeared higher. The variation in the distribution of stroke severity, as indicated by the admission and discharge NIHSS scores, showed a statistically significant difference between the two groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This finding supports the hypothesis that the presence of stenosis has an impact on the severity and clinical outcomes of ischemic stroke. This result aligns with previous research conducted by Jeng et al. and Xu et al., who found that patients with middle cerebral artery (MCA) stenosis had higher NIHSS scores upon admission and experienced worse clinical outcomes compared to those without stenosis.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Middle cerebral artery stenosis can cause ischemia in various important areas of the brain, such as the insula, basal ganglia, and the cortex of the frontal, temporal, and parietal lobes.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Furthermore, stenosis also has the potential to trigger hemodynamic instability and increase the risk of stroke-in-evolution, where neurological deficits progressively worsen due to decreased perfusion.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e In cases of severe stenosis, collateral flow limitation also increases the size of the infarct core, decreases the ASPECTS score, and further worsens the clinical severity assessed by NIHSS.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Patients with stenosis in this study demonstrated a more severe clinical profile, characterized by lower ASPECTS scores and higher NIHSS scores on both admission and discharge. These findings indicate that the presence of middle cerebral artery stenosis is linked to more extensive damage to brain tissue and a higher level of neurological severity, which could theoretically lead to poorer outcomes, such as increased mortality. These results also align with earlier studies that have shown patients with middle cerebral artery stenosis are at a greater risk of facing complications and experiencing higher rates of death.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Thus, although statistically the difference in mortality in this study was not significant, the presence of one case of death in the stenosis group still reflects a tendency for poor outcomes and it should be considered in the prediction assessment for patients who have had an ischemic stroke and have narrowing in the middle cerebral artery.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eLimitation of Study\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations that should be considered when interpreting the results. The retrospective design, using secondary data from medical records, makes researchers highly dependent on the completeness and accuracy of previous data, which can introduce potential bias. Clinical outcome assessments only used NIHSS and ASPECTS scores without long-term functional evaluations such as the modified Rankin Scale (mRS), thus not fully reflecting the level of disability in post-stroke patients. Furthermore, several factors that may influence the recovery process, such as comorbidities, lifestyle, medication adherence, and access to rehabilitation, have not been further analyzed. The modality used to assess stenosis in this study was limited to Transcranial Doppler (TCD), without confirmation by other imaging techniques such as CT angiography, MR angiography, or Digital Subtraction Angiography (DSA). Another limitation of this study is that the data came from only one institution, so there may be differences in characteristics from other institutions. Future research could include multicenter studies to more comprehensively assess the risk factors for MCA stenosis.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eOlder age, hypertension, hyperlipidemia, smoking, Diabetes Mellitus, aphasia, decrease level of consciousness, balance disorder, visual disturbance, and lower ASPECT plays a role in the occurrence of MCA stenosis in acute ischemic stroke patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthical Approval\u003c/strong\u003e \u003cp\u003e This research has received ethical approval from the Research Ethics Committee of Padjadjaran University, as documented in decree number 327/UN6.KEP/EC/2025. Additionally, the research has been granted permission to carry out the study and collect data from the Hasan Sadikin Hospital Ministry of Health, with reference number DP.04.03/D.XIV.4.4/1499/2025. The study adhered to all applicable ethical guidelines, including the Declaration of Helsinki. Each participant was fully informed about the\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eInformed Consent\u003c/h2\u003e \u003cp\u003e All participants provided informed and written consent prior to their involvement in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting Interests\u003c/strong\u003e \u003cp\u003eThe author confirms that there are no known competing financial interests or personal relationships that could have influenced the findings or conclusions presented in this paper.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLA: made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGorelick PB, Wong KS, Bae HJ, Pandey DK. 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Correlation between Lpa, APO-A, APO-B, and Stenosis of Middle Cerebral Artery in Patients with Cerebral Ischemic Stroke. \u003cem\u003eEmerg Med Int\u003c/em\u003e 2022, 1\u0026ndash;7 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu W, Zhang X, Chen H, Zhao Z, Zhu M. Prevalence and outcome of young stroke patients with middle cerebral artery stenosis. BMC Neurol. 2021;21:99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePinzon R, Wijono AD. Intracranial stenosis in patients with post-ischemic stroke: a case-control study Rizaldy Pinzon1, Andre Dharmawan Wijono1. Bali Med J. 2021;10:69\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOjha R, et al. Distribution of ischemic infarction and stenosis of intra- and extracranial arteries in young Chinese patients with ischemic stroke. BMC Cardiovasc Disord. 2015;15:158.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSakinah S, Nugroho SD. 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(2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuybu O, Tadi P, Dossani RH. \u003cem\u003ePosterior Cerebral Artery Stroke\u003c/em\u003e. (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVincent M, Sereke SG, Nassanga R, Robert M, Ameda F. Correlation between clinical and brain computed tomography findings of stroke patients: A cross-sectional study. Health Sci Rep 6, (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchlemm E, Cheng B, Thomalla G, Kessner SS. Functional Lesion Network Mapping of Sensory Deficits After Ischemic Stroke. Stroke. 2023;54:2918\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarriott AM, Karakaya F, Ayata C. Headache after ischemic stroke. Neurology 94, (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePop N, et al. The Alberta Stroke Program Early CT score (ASPECTS): A predictor of mortality in acute ischemic stroke. Exp Ther Med. 2021;22:1371.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEsmael A, Elsherief M, Eltoukhy K. Predictive Value of the Alberta Stroke Program Early CT Score (ASPECTS) in the Outcome of the Acute Ischemic Stroke and Its Correlation with Stroke Subtypes, NIHSS, and Cognitive Impairment. Stroke Res Treat. 2021;2021:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmalia L et al. Clinical Significance Alberta Stroke Program Early Computed Tomography Score (ASPECTS) And National Institute Of Health Stroke Score (NIHSS) On First Ever Acute Ischemic Stroke Patients. Internet J Neurol 21, (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu S et al. Reperfusion Into Severely Damaged Brain Tissue Is Associated With Occurrence of Parenchymal Hemorrhage for Acute Ischemic Stroke. Front Neurol 11, (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie G, et al. Imaging-based machine learning to evaluate the severity of ischemic stroke in the middle cerebral artery territory. BMC Med Imaging. 2025;25:199.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim J. Pictorial Essay: Transcranial Doppler Findings of the Intracranial and Extracranial Diseases. J Neurosonol Neuroimag. 2019;11(1):2\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"ischemic stroke, middle cerebral artery stenosis, risk factors, ASPECTS, NIHSS, clinical outcome","lastPublishedDoi":"10.21203/rs.3.rs-8943637/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8943637/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction: Ischemic stroke with stenosis of the middle cerebral artery (MCA) is recognized as a critical factor associated with more severe neurological deficits and worse clinical outcomes. This study will examine the comparative characteristics and outcomes between ischemic stroke patients with and without MCA stenosis.\u003c/p\u003e \u003cp\u003eMethods: A retrospective comparative analytic study was conducted using medical records of ischemic stroke patients who underwent Transcranial Doppler (TCD) examination. Patients were divided into two groups: with and without MCA stenosis. Statistical significance calculated with Mann-Whitney test, ANOVA, and multiple logistic regression.\u003c/p\u003e \u003cp\u003eResults: There were 206 patients included in this study, divided into 103 patients with intracranial stenosis and 103 patients with non-intracranial stenosis. Patients with MCA stenosis were predominantly older than 45 years (p\u0026thinsp;=\u0026thinsp;0.043) and had history of hypertension, dyslipidemia, diabetes mellitus, and smoking history (p\u0026thinsp;=\u0026thinsp;0.012; p\u0026thinsp;=\u0026thinsp;0.005; p\u0026thinsp;=\u0026thinsp;0.016; and p\u0026thinsp;=\u0026thinsp;0.048, respectively). Decreased level of consciousness (p\u0026thinsp;=\u0026thinsp;0.045), language impairment (p\u0026thinsp;=\u0026thinsp;0.001), visual impairment (p\u0026thinsp;=\u0026thinsp;0.005), and balance impairment (p\u0026thinsp;=\u0026thinsp;0.009) were more frequent in the stenosis group. A lower ASPECTS score (\u0026le;\u0026thinsp;7) was significantly more common (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and both admission and discharge NIHSS scores indicated greater neurological severity in patients with stenosis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). From logistic regression, we found that older age, hypertension, hyperlipidemia, smoking, Diabetes Mellitus, aphasia, decrease level of consciousness, balance disorder, visual disturbance, and lower ASPECT, was statistically significance correlate with intracranial stenosis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eConclusion: Older age, hypertension, hyperlipidemia, smoking, Diabetes Mellitus, aphasia, decrease level of consciousness, balance disorder, visual disturbance, and lower ASPECT plays a role in the occurrence of MCA stenosis in acute ischemic stroke patients. The modality used to assess MCA stenosis in this study was limited to Transcranial Doppler (TCD), without confirmation by other imaging techniques.\u003c/p\u003e","manuscriptTitle":"Factors That Influence the Occurrence of Middle Cerebral Artery Stenosis in Ischemic Stroke Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-27 12:28:55","doi":"10.21203/rs.3.rs-8943637/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-17T02:12:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204962551817432571454634162691611223221","date":"2026-04-03T18:04:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"27287864116299923088362164478566735245","date":"2026-03-25T07:38:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-25T07:33:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-03T05:28:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-02T09:55:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-02T09:51:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Neurology","date":"2026-02-23T06:26:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"719a06aa-a077-4d11-be68-af3514f30c47","owner":[],"postedDate":"March 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-27T12:28:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-27 12:28:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8943637","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8943637","identity":"rs-8943637","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}