Prognosis of Isolated Symptomatic Middle Cerebral Artery Stenosis

ABSTRACT

BACKGROUND: Middle cerebral artery (MCA) stenosis is relatively an uncommon disorder that has not been studied as extensively as extracranial or intracranial internal carotid artery. The long term risk of recurrent stroke or transient ischemic attack (TIA) in patients with isolated symptomatic MCA stenosis remains controversial. Transcranial Doppler sonography (TCD) and magnetic resonance angiography (MRA) are excellent noninvasive tools for a prospective study of MCA stenosis and obstruction. We evaluated the prognosis of isolated symptomatic MCA stenosis prospectively. METHODS: We studied 14 symptomatic patients aged 30-56 years with isolated MCA stenosis who had had TIA or minor stroke. Ten patients had history of two or even more stereotyped TIA or stroke and four patients had a history of single TIA or minor stroke. MCA stenosis was assessed by MRA, TCD and/or conventional angiography (CA) in selected cases at entry. CA and/or MRA showed MCA stenosis in the M1 segment in all patients without the evidence of the widespread atherosclerotic disease. Patients with the potentials of embolic source in the heart or the proximal vessel system were excluded. All patients were treated with antiplatelet agents or anticoagulants. The mean duration of follow-up was 22 months (3-39 months) and TCD was done in 2 to 12 month interval. RESULTS: During follow-up, one of 14 patients had TIAs, the other 13 patients experienced neither subsequent transient attack nor new stroke. TCD demonstrated regression of stenosis in 7 patients, and progression in one patient. TCD findings did not change in 6 patients. CONCLUSIONS: These findings suggest that the prognosis is good for patients with isolated symptomatic MCA stenosis under treatment with antiplatelet agents or anticoagulants.