To study the risk factors for acute ischemic stroke in middle-aged and young patients with cerebrovascular stenosis in Xinjiang. Methods: Clinical data of 130 middle-aged and young patients with acute ischemic stroke were collected. Cases were divided into the cerebrovascular stenosis group (n=64) and the no cerebrovascular stenosis group (n=66). Stenosis group was further divided into mild stenosis group (n=16), moderately severe stenosis group (n=17), and occlusion group (n=31). Data was collected on patient serum levels of triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, as well as history of high blood pressure, history of diabetes, and BMI. Data was analyzed for correlation between serum lipid index and degree of cerebrovascular stenosis, and analysis of risk factors for cerebrovascular stenosis was performed. Results: Hypertension of ≥ 10 years, TC, and TC/HDL-C were significantly different between the cerebrovascular stenosis group and no cerebrovascular stenosis group (P<0.05). TC and TC/HDL-C were positively correlated with cerebrovascular stenosis degree (P<0.01). Serum TC level and TC/HDL-C were significantly lower in the moderate and mild stenosis groups than in the occlusion group (P<0.05). Hypertension of ≥10 years and TC/HDL-C were independent risk factors for middle-aged and young patients of ischemic stroke with cerebrovascular stenosis (P<0.05). Con? clusion: Serum TC and TC/HDL-C were closely related with degree of cerebrovascular stenosis in middle-aged and young patients of acute ischemic stroke in Xinjiang. Hypertension of ≥10 years and TC/HDL-C can thus be considered risk factors for middle-aged and young acute ischemic stroke with cerebrovascular stenosis．