Clinical Manifestations of Isolated Chronic Middle Cerebral Artery Occlusion in Relation to Angiographic Features
Hee Sup Shin1, Chang-Woo Ryu2, Hak Cheol Ko1
1Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
Insights
Good collateral blood flow in chronic middle cerebral artery occlusion (ChMCAO) is linked to fewer initial symptoms and reduced risk of recurrent ischemic events. Poor collateral flow indicates a higher risk for stroke recurrence.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Isolated chronic middle cerebral artery occlusion (ChMCAO) is a recognized cause of hemodynamic stroke.
- Understanding the relationship between collateral circulation and clinical outcomes in ChMCAO is crucial for patient management.
Purpose of the Study:
- To investigate the association between angiographic collateral flow and clinical manifestations in patients with isolated ChMCAO.
- To compare the prognosis, specifically symptom recurrence, based on the degree of collateral circulation.
Main Methods:
- A retrospective analysis of 56 patients diagnosed with isolated ChMCAO.
- Patients were stratified into 'poor' and 'good' anterograde collateral flow (AF) groups based on angiography.
- Neurologic symptoms and recurrence rates were compared between the two groups.
Main Results:
- The poor AF group (33 patients) exhibited a significantly higher prevalence of ischemic symptoms compared to the good AF group (23 patients).
- Over a mean follow-up of 33.8 months, 6 out of 45 patients experienced recurrent ipsilateral symptoms.
- Poor AF was associated with a 5.36-fold increased hazard ratio for recurrent symptoms.
Conclusions:
- Anterograde collateral flow through the basal collateral network appears to influence the clinical presentation of ChMCAO.
- Adequate collateral circulation in isolated ChMCAO may be a protective factor against recurrent ischemic events.
Objective:
Isolated chronic middle cerebral artery occlusion (ChMCAO) is not a rare condition and is known to cause hemodynamic stroke. The purpose of this study was to evaluate differences in clinical manifestations and prognosis of isolated ChMCAO in relation to angiographic features.
Methods:
This retrospective study enrolled 56 patients with isolated ChMCAO. In accordance with degree of anterograde collateral flow (AF) on angiography, patients were categorized into poor and good AF groups. The 2 groups were assessed and compared for the presence and recurrence of neurologic symptoms.
Results:
Of 56 patients, 33 were in the poor AF group and 23 were in the good AF group. The prevalence of ischemic symptoms was significantly higher in the poor AF group compared with the good AF group (P < 0.05). During an average follow-up period of 33.8 months, recurrent ipsilateral symptoms occurred in 6 of 45 patients. The hazard ratio conferred by poor AF was 5.36 (95% confidence interval, 1.08-26.57) for recurrent symptoms.
Conclusions:
AF through the basal collateral network may be related to clinical manifestations of ChMCAO. Good AF in isolated ChMCAO may play an important role in preventing recurrence of an ischemic event.
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