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Published on: September 25, 2009
Middle cerebral artery endarterectomy: experience with two cases
G E Kraus1, J M Herman, K S Lee
1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Background:
Atherosclerotic stenosis of the middle cerebral artery (MCA) is uncommon and long-term prognosis is not well defined. Methods of treating stenosis of the MCA range from the administration of anticoagulants to endarterectomy.
Methods:
We present two cases of patients with focal symptomatic stenosis of the MCA with evidence of focally decreased cerebral blood flow and compromise of cerebral blood flow reserves on xenon-enhanced computed tomography (Xe CT) scanning. Endarterectomies were performed after unsuccessful anticoagulation therapy.
Results:
Both patients underwent successful endarterectomies of the MCA. Improvement in cerebral blood flow postoperatively was documented for both patients. At last follow-up neither patient had demonstrated any additional ischemic episodes.
Conclusions:
Atherosclerotic stenosis of the MCA may be responsible for distal emboli and compromised hemodynamics, and endarterectomy of this vessel may provide definitive therapy.
Insights
Atherosclerotic stenosis of the middle cerebral artery (MCA) is rare. Surgical endarterectomy effectively restored blood flow and prevented further ischemic events in two patients.
Area of Science:
- Neurology
- Vascular Surgery
Background:
- Atherosclerotic stenosis of the middle cerebral artery (MCA) is uncommon, with poorly defined long-term prognoses.
- Treatment options for MCA stenosis include anticoagulation and endarterectomy.
Observation:
- Two patients with symptomatic MCA stenosis and reduced cerebral blood flow reserves underwent endarterectomy after failed anticoagulation.
- Xenon-enhanced computed tomography (Xe CT) scanning confirmed focal stenosis and compromised cerebral blood flow.
Findings:
- Successful MCA endarterectomy was performed in both patients.
- Postoperative Xe CT demonstrated improved cerebral blood flow.
- Neither patient experienced further ischemic episodes during follow-up.
Implications:
- Atherosclerotic MCA stenosis can cause distal emboli and hemodynamic compromise.
- MCA endarterectomy may offer a definitive treatment for this condition.
