In this study, we used whole-brain vessel wall imaging (VWI) to characterize morphologies of middle cerebral artery (MCA) occlusion in patients with MMD, and explore their relationship to clinical findings. We found that plugged MCA was associated with ischemic stroke, however, vanishing MCA correlated with intraventricular hemorrhage. We also found that hemispheres with vanishing MCA manifested a higher degree of lenticulostriate artery (LSA) dilation and proliferation. The results suggest that there are two types of MCA occlusion in MMD, correlating with different stroke types and extent of perforator proliferation. Morphological analysis of occluded MCA using VWI may help understand the stroke mechanism of MMD.