[Symptomatic stenoses of the middle cerebral artery]

The clinical angiographic and prognostic features of 13 patients with symptomatic stenosis of the middle cerebral artery (MCA) admitted between 1970 and 1981 have been reviewed. The etiology of the stenosis was probably atherosclerosis, except in 1 case due to fibro-muscular dysplasia, 1 with post-radiation angiopathy and 2 related to oral contraceptives. Two main clinical groups were delineated: 1) transitory and minor ischemic accidents always arising in the same arterial area; these occurred in older patients with multiples atheromatous lesions along the carotid artery. 2) progressive--or stepwise--strokes occurring in younger patients, mainly females, with isolated MCA stenosis. These cerebrovascular symptoms and signs, in the absence of carotid bruit, Doppler ultrasonography abnormality or evidence of cardiac embolism should suggest intracranial stenosis and require appropriate therapy to avoid complete occlusion. Our study shows that early medical treatment--anti-coagulation, then antiaggregation--provides a suitable alternative to EC/IC bypass. This is suggested by evidence for micro-embolization in addition to hemodynamic mechanisms.