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

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.