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Prognosis of asymptomatic stenosis of the middle cerebral artery

Department of Neurology, University Hospital of Zürich, Switzerland

Correspondence to:
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{at}nch.ma.uni-heidelberg.de

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.

Abbreviations: MCAS, middle cerebral artery stenosis; TCCS, transcranial colour duplex sonography

Keywords: middle cerebral artery; stenosis

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