In the current issue of Atherosclerosis, Zhang et al. explore the usefulness of a combination of transcranial Doppler (TCD) and ultrasound Doppler of the extracranial carotid arteries in assessing the disease of middle cerebral artery (MCA) and its various morphologic patterns [1]. While intracranial atherosclerotic disease (ICAD) is the underlying etiology for nearly 10% of ischemic strokes in Caucasians, it can account for up to 50% of ischemic strokes in the south and east Asian population and results from complications of atherosclerotic plaques affecting major intracranial arteries [2,3].