Objective: This study aims to explore the prognostic influencing factors of patients with acute ischemic stroke evaluated based on Transcranial doppler (TCD) and carotid artery ultrasound. Methods: 120 patients diagnosed with acute ischemic stroke in our hospital from January 2022 to January 2024 were selected as the research subjects. All patients were followed up for 6 months after treatment. According to the different prognostic conditions of the patients, they were divided into the good prognosis group and the poor prognosis group. The hemodynamic indicators and carotid artery lesion parameters of the patients were collected by TCD and carotid artery ultrasound. Collect and compare the baseline data of the patients. The influencing factors of poor prognosis of acute ischemic stroke were evaluated through Logistic regression analysis. Results: Among the 120 patients, 72 cases (60%) had a good prognosis and 48 cases (40%) had a poor prognosis. The age of the poor prognosis group was significantly greater than that of the good prognosis group (P<0.05), but there were no significant differences in gender, etiology of stroke and previous medical history between the two groups (P>0.05). The peak flow velocity and average flow velocity of the middle artery in the good prognosis group were significantly higher than those in the poor prognosis group, while the carotid intima-media thickness, carotid stenosis rate, unstable plaque rate, NIHSS score, blood glucose, TC, TG, LDL-C and CRP levels were significantly lower than those in the poor prognosis group (P<0.05). Logistic regression analysis showed that age, NIHSS score, carotid artery stenosis rate, peak middle artery flow velocity, unstable plaque, blood glucose, total cholesterol, triglycerides and C-reactive protein were all independent risk factors for poor prognosis of stroke (P<0.05). The average flow velocity of the middle artery and the intima-media thickness of the carotid artery had no significant correlation with poor prognosis (P>0.05). Conclusion: TCD and carotid artery ultrasound parameters are related to the prognosis of patients with acute ischemic stroke. Carotid artery stenosis rate, peak middle artery flow velocity, and unstable plaques are all risk factors for poor prognosis of stroke.