Prognosis of asymptomatic stenosis of the middle cerebral artery

Background: The risk of ischaemic events in asymptomatic intracranial atherosclerosis is unknown. Objective: To follow up patients with asymptomatic atherosclerotic middle cerebral artery stenosis (MCAS) to evaluate the long term stroke risk in its territory. Methods: Consecutive white patients with...

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Bibliographic Details
Published in:	Journal of neurology, neurosurgery and psychiatry Vol. 75; no. 9; pp. 1300 - 1303
Main Authors:	Kremer, C, Schaettin, T, Georgiadis, D, Baumgartner, R W
Format:	Journal Article
Language:	English
Published:	London BMJ Publishing Group Ltd 01-09-2004 BMJ BMJ Publishing Group LTD BMJ Group
Subjects:	Adult Aged Aged, 80 and over Aneurysms Asymptomatic Atherosclerosis Biological and medical sciences Brain Ischemia - etiology Brain Ischemia - prevention & control Cardiovascular disease Carotid arteries Cerebral Arterial Diseases - pathology Cigarettes Clinical Medicine Constriction, Pathologic Diabetes Doppler effect Embolisms Female Fibrinolytic Agents - therapeutic use Follow-Up Studies Heart attacks Humans Hypertension Intracranial Thrombosis - etiology Intracranial Thrombosis - prevention & control Investigations Ischemia Klinisk medicin Male MCAS Medical and Health Sciences Medical sciences Medicin och hälsovetenskap Middle Aged middle cerebral artery Middle Cerebral Artery - pathology middle cerebral artery stenosis Neurologi Neurology Prognosis Risk Factors Smoking stenosis Stroke TCCS transcranial colour duplex sonography Ultrasonic imaging Vein & artery diseases Stenosis Nervous system diseases Asymptomatic Prognosis Middle cerebral artery
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Summary:	Background: The risk of ischaemic events in asymptomatic intracranial atherosclerosis is unknown. Objective: To follow up patients with asymptomatic atherosclerotic middle cerebral artery stenosis (MCAS) to evaluate the long term stroke risk in its territory. Methods: Consecutive white patients with asymptomatic atherosclerotic MCAS were enrolled. Patients with MCAS of possible or proven non-atherosclerotic origin were excluded. MCAS was assessed by transcranial colour duplex sonography according to published angiography validated criteria. Medical treatment was given at the discretion of the treating physician. Results: 50 patients were included and followed for (mean (SD)) 815 (351) days; three were lost to follow up. MCAS was <50% in 38 and ⩾50% in 12. No patient suffered an ischaemic event in the MCAS territory; one had a transient ischaemic attack in the contralateral hemisphere. Three patients died, one from a subdural haematoma in the contralateral hemisphere, and two from non-stroke-related causes. Medical treatment at baseline included antithrombotic drugs in 42 cases (antiplatelet agent, n = 39; warfarin, n = 3), and statins in 22; at the end of follow up 45 of the 47 survivors were on antithrombotic drugs (antiplatelet agent, n = 37; warfarin, n = 8), and 30 were on statins. Conclusions: Asymptomatic MCAS of atherosclerotic origin appears to have a benign long term prognosis with a low risk of ipsilateral stroke in medically treated white patients.
Bibliography:	istex:1711836358EE94B4B498EAA847BB185344574D91 local:0751300 ark:/67375/NVC-LRMFZLL3-J Correspondence to:  Dr Christine Kremer  Neurosurgery Department, University Heidelberg, Faculty of Clinical Medicine Mannheim, Theodor-Kutzer-Ufer 1-3, D-68135 Mannheim, Germany; christine.kremer@nch.ma.uni-heidelberg.de href:jnnp-75-1300.pdf PMID:15314120 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0022-3050 1468-330X 1468-330X
DOI:	10.1136/jnnp.2003.017863