Atherosclerotic disease of the middle cerebral artery.

Abstract

SUMMARY Three hundred and fifty-two patients with atherosclerotic middle cerebral artery stenosis (MCAS, 53%) or occlusion (MCAO, 47%) have been systematically studied. The study involved all patients entered into the EC/IC Bypass Study with isolated MCA disease or a tandem lesion predominating in the MCA ipsilateral to the ischemic events (18 patients with a tandem lesion of greater magnitude in the internal carotid artery were not included). The Asian patients represented 58% of all Asians entered into the EC/IC Bypass Study, whereas the white patients represented 18% of all whites and the black patients 34% of all blacks. Isolated TIAs were less frequent in MCAO (12%) than in MCAS (34%). Warning TIAs before a stroke occurred in one third of the cases. Presentation with stroke or isolated TIA was not influenced by sex, age, level of MCA obstruction, collateral circulation nor associated carotid disease. In MCAS, no major difference in presentation was found between severe and moderate stenosis. Pure motor hemiparesis occurred in 15% and pure sensory stroke in 2% of the patients with stroke and 30% of the MCA territory infarcts were small and limited to the lentkulocapsular area, confirming that so-called lacunar infarcts may be due to large vessel disease.During follow-up (42 months) of 164 medically-treated patients, further cerebrovascular events (TIA and stroke) occurred in 11.7% of the patients per year. In MCAO the stroke rate was 10.1 % per patient-year and the ipsilateral infarct rate was 7.1% per patient-year. In MCAS, the stroke rate was 9.5% per patientyear and the ipsilateral stroke rate was 7.8% per patient-year. The location and severity of lesion did not influence the occurrence of ipsilateral ischemic events during follow-up. Reopening of an artery-to-artery embolic occlusion of the MCA, with subsequent embollc reocclusion, may explain some of the ipsilateral ischemic events during follow-up. The annual death rate was 3.3% in MCAS and 2.6% in MCAO. Less than 15% of the survivors were severely disabled at the end of follow-up and nearly two-thirds were able to resume previous activities both hi MCAO and MCAS. The type of delayed ischemic events tended to be the same as that of the presenting event, but no factor could significantly predict the occurrence of stroke or death. This study suggests that long-term prognosis of patients with MCA occlusion, who present with TIA or non-devastating stroke, is reasonable.

Prognostic factors and therapeutic outcome of isolated symptomatic middle cerebral artery stenosis

“…A previous reports (Bogousslavsky et al, 1986), as well as in our report, the location of MCA stenosis most commonly occurred at the origin of the artery, which accounted for 73% of our cases. MRI revealed striatocapsular infarction (basal ganglia, internal capsule and corona radiata), which might suggest that occlusion occurred at the M1 segment of MCA and blockage of the orifices of the lenticulostriate arteries.…”

“…A previous reports (Bogousslavsky et al. , 1986), as well as in our report, the location of MCA stenosis most commonly occurred at the origin of the artery, which accounted for 73% of our cases.…”

Prognostic factors and therapeutic outcome of isolated symptomatic middle cerebral artery stenosis

“…A previous reports (Bogousslavsky et al, 1986), as well as in our report, the location of MCA stenosis most commonly occurred at the origin of the artery, which accounted for 73% of our cases. MRI revealed striatocapsular infarction (basal ganglia, internal capsule and corona radiata), which might suggest that occlusion occurred at the M1 segment of MCA and blockage of the orifices of the lenticulostriate arteries.…”

“…A previous reports (Bogousslavsky et al. , 1986), as well as in our report, the location of MCA stenosis most commonly occurred at the origin of the artery, which accounted for 73% of our cases.…”

Six-month follow-up study in patients with symptomatic intracranial arterial stenosis

“…In the ECA/ICA (external/internal carotid artery) bypass study, the annual risks of ipsilateral stroke and fatal stroke were found to be 7.8% and 9.5%, respectively, in patients with symptomatic MCA stenosis, despite medical treatment. 10,12,13 In our study, we also observed 13 (34%) recurrent strokes in 38 patients during the 6-month follow-up period.…”

Intracranial atherosclerosis is the most common stroke subtype: Ten-year data from hyderabad stroke registry (India)

“…[ 4 6 7 11 12 14 15 16 17 18 ] A recent study from India reported ischemic stroke subtypes in a hospital population across different centers, and while the proportion of LAA was the highest similar to our study, the proportion of extracranial and intracranial large artery disease was not reported. [ 11 ] Extracranial LAA dominated composition of LAA in Western countries,[ 19 20 21 ] but intracranial LAA accounted for nearly 80% of LAA in the Hyderabad registry, consistent with reports from other East and South Asian countries,[ 7 22 23 ] thereby confirming that intracranial LAA is the prominent subtype of LAA across Asia. In contrast, SVO or lacunar stroke contributed to 19.9% of all ischemic strokes, and this proportion is less than reported from China (42.2%),[ 15 ] Taiwan (32.7%),[ 16 ] Korea (25.4%),[ 7 ] and Japan (34.2%)[ 17 ] while more comparable to data from the West (range: 15%–23%).…”

Prognostic factors and therapeutic outcome of isolated symptomatic middle cerebral artery stenosis

“…A previous reports (Bogousslavsky et al, 1986), as well as in our report, the location of MCA stenosis most commonly occurred at the origin of the artery, which accounted for 73% of our cases. MRI revealed striatocapsular infarction (basal ganglia, internal capsule and corona radiata), which might suggest that occlusion occurred at the M1 segment of MCA and blockage of the orifices of the lenticulostriate arteries.…”

“…A previous reports (Bogousslavsky et al. , 1986), as well as in our report, the location of MCA stenosis most commonly occurred at the origin of the artery, which accounted for 73% of our cases.…”

Six-month follow-up study in patients with symptomatic intracranial arterial stenosis

“…In the ECA/ICA (external/internal carotid artery) bypass study, the annual risks of ipsilateral stroke and fatal stroke were found to be 7.8% and 9.5%, respectively, in patients with symptomatic MCA stenosis, despite medical treatment. 10,12,13 In our study, we also observed 13 (34%) recurrent strokes in 38 patients during the 6-month follow-up period.…”

Intracranial atherosclerosis is the most common stroke subtype: Ten-year data from hyderabad stroke registry (India)

“…[ 4 6 7 11 12 14 15 16 17 18 ] A recent study from India reported ischemic stroke subtypes in a hospital population across different centers, and while the proportion of LAA was the highest similar to our study, the proportion of extracranial and intracranial large artery disease was not reported. [ 11 ] Extracranial LAA dominated composition of LAA in Western countries,[ 19 20 21 ] but intracranial LAA accounted for nearly 80% of LAA in the Hyderabad registry, consistent with reports from other East and South Asian countries,[ 7 22 23 ] thereby confirming that intracranial LAA is the prominent subtype of LAA across Asia. In contrast, SVO or lacunar stroke contributed to 19.9% of all ischemic strokes, and this proportion is less than reported from China (42.2%),[ 15 ] Taiwan (32.7%),[ 16 ] Korea (25.4%),[ 7 ] and Japan (34.2%)[ 17 ] while more comparable to data from the West (range: 15%–23%).…”

Prognostic factors and therapeutic outcome of isolated symptomatic middle cerebral artery stenosis

“…A previous reports (Bogousslavsky et al, 1986), as well as in our report, the location of MCA stenosis most commonly occurred at the origin of the artery, which accounted for 73% of our cases. MRI revealed striatocapsular infarction (basal ganglia, internal capsule and corona radiata), which might suggest that occlusion occurred at the M1 segment of MCA and blockage of the orifices of the lenticulostriate arteries.…”

“…A previous reports (Bogousslavsky et al. , 1986), as well as in our report, the location of MCA stenosis most commonly occurred at the origin of the artery, which accounted for 73% of our cases.…”

Six-month follow-up study in patients with symptomatic intracranial arterial stenosis

“…In the ECA/ICA (external/internal carotid artery) bypass study, the annual risks of ipsilateral stroke and fatal stroke were found to be 7.8% and 9.5%, respectively, in patients with symptomatic MCA stenosis, despite medical treatment. 10,12,13 In our study, we also observed 13 (34%) recurrent strokes in 38 patients during the 6-month follow-up period.…”

Intracranial atherosclerosis is the most common stroke subtype: Ten-year data from hyderabad stroke registry (India)

“…[ 4 6 7 11 12 14 15 16 17 18 ] A recent study from India reported ischemic stroke subtypes in a hospital population across different centers, and while the proportion of LAA was the highest similar to our study, the proportion of extracranial and intracranial large artery disease was not reported. [ 11 ] Extracranial LAA dominated composition of LAA in Western countries,[ 19 20 21 ] but intracranial LAA accounted for nearly 80% of LAA in the Hyderabad registry, consistent with reports from other East and South Asian countries,[ 7 22 23 ] thereby confirming that intracranial LAA is the prominent subtype of LAA across Asia. In contrast, SVO or lacunar stroke contributed to 19.9% of all ischemic strokes, and this proportion is less than reported from China (42.2%),[ 15 ] Taiwan (32.7%),[ 16 ] Korea (25.4%),[ 7 ] and Japan (34.2%)[ 17 ] while more comparable to data from the West (range: 15%–23%).…”