Association Between Transcranial Doppler–Detected Middle Cerebral Artery Stenosis and Stroke Severity in Acute Ischemic Stroke

Abstract Background Trancranial Doppler (TCD) provides a non-invasive bedside assessment of intracranial blood-flow hemodynamics, but the relationship between TCD-detected middle cerebral artery (MCA) abnormalities and neurological severity at presentation remains incompletely characterized. Objective To evaluate the association between TCD-detected MCA stenosis and admission stroke severity, as measured by the National Institutes of Health Stroke Scale (NIHSS), in patients with acute ischemic stroke. Methods This retrospective cross-sectional exploratory study included 50 consecutive adult patients with acute ischemic stroke who underwent TCD examination of the MCA. MCA stenosis was classified according to predefined TCD hemodynamic criteria. Stroke severity was assessed using the NIHSS at admission. Continuous variables were summarized according to their distribution, and categorical variables were presented as frequencies and percentages. Between-group comparisons were performed using the Mann–Whitney U and Chi-square or Fisher’s exact tests, as appropriate. Results TCD-detected MCA stenosis was identified in 34 of 50 patients (68.0%). Patients with MCA stenosis had higher admission NIHSS scores than those without stenosis. The median NIHSS was 10 in patients with stenosis and 4.5 in those without stenosis ( p < 0.001). MCA stenosis was also more frequently observed among patients with moderate-to-severe stroke severity. Conclusion In this retrospective cross-sectional cohort, TCD-detected MCA stenosis was associated with higher admission NIHSS scores in patients with acute ischemic stroke. The findings suggest that TCD-detected MCA hemodynamic abnormalities may provide complementary information regarding early neurological severity. However, the study does not establish causality, atherosclerotic etiology, or independent prognostic value. Confirmation in larger studies incorporating infarct territory, vascular imaging, systemic hemodynamic variables, and reperfusion status is warranted.