Middle cerebral artery occlusion: correlation of computed tomography and angiography with clinical outcome.

Abstract

The clinical outcome of 40 cases with middle cerebral artery (MCA) occlusion was examined in relation to the site of occlusion and the findings on computed tomography (CT). Patients were treated conservatively without surgery. A few had decompressive craniotomy when necessary. Outcome in 7 (18%) was good, in 6 (15%) moderate, and in 15 (38%) severe; 12 (30%) died by the follow-up at 3 months. In cases with occlusion at the origin of the MCA, hypodensity on CT scan was usually localized to the basal ganglia, presumably because of collateral circulation through the anterior cerebral arteries; the outcome in these patients was not always favorable. Cases with occlusion of the trunk or branch vessels always showed marked CT hypodensity, and clinical outcome was poor. To assess quantitatively the extent of collateral circulation, the conduction time of contrast medium from the intracranial siphon (IC) to the insular portion of the MCA (M2) through the anterior cerebral arteries was calculated on serial carotid angiograms obtained within 24 hours after stroke onset. An IC-M2 time of 5 seconds was a critical indicator of whether extensive CT hypodensity would develop (the rule of 5 seconds). Furthermore, this method predicted the appearance and extent of infarction before CT revealed hypodensity. The significance of acute reconstructive surgery is also discussed. (Stroke 1987;18:863-868)T here have been surprisingly few reports of the prognosis of patients with major cerebral arterial branch occlusions, particularly of the middle cerebral artery (MCA).1 " 6 The prognosis of cases with MCA occlusion varies widely in the literature, with mortality ranging from 5 to 40%, and seems to depend to a great extent on the site of occlusion. However, only Lascelles and Burrows 4 and Moulin et al 6 examined the relation between the site of occlusion of the MCA and the patient's prognosis. Recent advances in computed tomography (CT) technology have been helpful in clarifying the exact location and extent of the cerebral infarct. We found, however, no report on the prognosis of patients with MCA occlusion in relation to the findings on CT.Reports on reconstructive vascular surgery, such as embolectomy, are increasing.7 " 12 The results of such surgery have been varied, and the indications for surgery are not always clear. Positron emission tomography (PET) can demonstrate misery perfusion in the acute stage of cerebral ischemic disease. 13 Only Baron et al 14 report the results of operations in patients in whom miseiy perfusion was identified preoperatively on PET scan.Here we correlate the site of MCA occlusion, the location and extent of infarct on CT, and the clinical disability of patients studied within 1 week after onset. A method to measure quantitatively the collateral cirFrom the Neurosurgical Division, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka, Japan.Address for reprints: Isamu Saito, MD, Fuji Noken, 270-12, Sugita, Fujinomiya, Shizuoka-418, Japan. Received February 12, 1986; accepted April 20, 1987. cul...

Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

“…Qualitative assessment of hemodynamic and morphologic parameters of leptomeningeal collaterals has been used in catheter angiography grading systems and has been shown to predict a favorable outcome, [24][25][26] showing the importance of enhancement time for collateral quality. Saito et al 27 assessed the correlation of transit time from the ICA to the M2 segment with the lesion size on follow-up NECT. However, only a few patients were included and no statistical tests were performed.…”

Intra-Arterial Thrombolytic Therapy İn Acute İschemic Stroke: Uludag University Medical Faculty Neurology Clinic Experience

“…Ön sistem alanındaki inme olgularında 30 günlük ve 5 yıllık mortalite oranları sırasıyla %17 ve %40 olarak bildirilmiştir (6). Saito ve arkadaşlarının yaptığı ve 33 M1 oklüzyonunu içeren çalışmada %78 olguda ölüm ya da ciddi nörolojik defisit, %9 olguda iyi prognoz görülmüştür (7). Baziler Arter oklüzyonu olgularının prognozları ise çok daha kötüdür ve değişik serilerde mortalite oranları %80-90 oranlarında bildirilmiştir (8)(9).…”

Efficient non-viral transfection of adult neural stem/progenitor cells, without affecting viability, proliferation or differentiation

“…Unilateral occlusion of the middle cerebral artery (MCA) has been associated with up to 80% of ischemic stroke in humans [6][7][8] . Occlusion of the MCA is therefore considered to be one of the most clinically relevant models of ischemia.…”