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Symptomatic middle cerebral artery stenosis treated with intracranial angioplasty: experience in 32 patients
Woong Yoon1, Jeong Jin Seo, Ki Hyun Cho
1Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Dong-ku, Gwangju 501-757, South Korea. radyoon@cnuh.com
Purpose:
To retrospectively review the outcome after angioplasty in patients with symptomatic, high-grade middle cerebral artery (MCA) stenosis refractory to medical therapy.
Materials And Methods:
Institutional review board approval to perform angioplasty procedures for MCA stenosis was obtained, and written informed consent was obtained from each patient or the patient's family. Institutional review board approval was also obtained for the retrospective review of patients' data. The institutional review board waived the need for informed consent for this retrospective analysis.Thirty-two consecutive patients (18 men, 14 women; median age, 55 years) with symptomatic MCA stenosis greater than 70% underwent angioplasty between June 1994 and July 2003. The indication for angioplasty was recurrent transient ischemic attack (TIA) refractory to antithrombotic therapy in 24 patients and acute ischemic stroke in eight. Patient records were retrospectively reviewed for angiographic findings, periprocedural complications, and follow-up data.
Results:
Angioplasty reduced the degree of stenosis to less than 50% in 29 of 32 patients (91%). There were two major complications during angioplasty: acute occlusion of the treated MCA and vascular rupture that resulted in death. Thus, the risk of disabling stroke or death was 6% (two of 32 patients), and the mortality rate was 3% (one of 32 patients). The rate of periprocedural TIA was 19% (six of 32 patients). Five patients had asymptomatic intimal dissection. During the follow-up period, which ranged from 5 to 92 months (median, 20 months), TIA occurred in one patient in whom the results of angioplasty were suboptimal. The remaining 29 patients did not experience further ischemic events attributable to the treated MCA stenosis during the follow-up period. Asymptomatic restenosis occurred in one of five patients in whom data from follow-up angiography were available.
Conclusion:
MCA angioplasty resulted in a low recurrence rate of ischemic symptoms during long-term follow-up.
Insights
Angioplasty effectively treated symptomatic middle cerebral artery (MCA) stenosis, significantly reducing stenosis and preventing recurrent ischemic events in most patients during long-term follow-up.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- High-grade middle cerebral artery (MCA) stenosis is a significant risk factor for ischemic stroke.
- Medical therapy for symptomatic MCA stenosis refractory to treatment has limited efficacy.
- Angioplasty offers a potential interventional solution for severe MCA stenosis.
Purpose of the Study:
- To evaluate the outcomes of angioplasty in patients with symptomatic, high-grade MCA stenosis resistant to medical management.
- To assess the safety and efficacy of angioplasty in reducing MCA stenosis and preventing subsequent ischemic events.
Main Methods:
- Retrospective review of 32 consecutive patients with >70% symptomatic MCA stenosis treated with angioplasty between 1994 and 2003.
- Indications for angioplasty included recurrent transient ischemic attack (TIA) or acute ischemic stroke refractory to antithrombotic therapy.
- Data collected included angiographic findings, periprocedural complications, and long-term follow-up for ischemic events and restenosis.
Main Results:
- Angioplasty successfully reduced stenosis to <50% in 91% of patients (29/32).
- Major periprocedural complications included acute MCA occlusion and vascular rupture, leading to death in one patient (3% mortality).
- The risk of disabling stroke or death was 6% (2/32), with a 19% periprocedural TIA rate (6/32). During a median 20-month follow-up, only one patient experienced recurrent TIA, and no further ischemic events occurred in the remaining 29 patients.
Conclusions:
- Middle cerebral artery (MCA) angioplasty is an effective treatment for high-grade stenosis refractory to medical therapy.
- The procedure achieves significant stenosis reduction and a low rate of recurrent ischemic symptoms during long-term follow-up.
- While periprocedural risks exist, angioplasty offers a viable option for selected patients with symptomatic MCA stenosis.