Prognosis of asymptomatic stenosis of the middle cerebral artery.
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 > or = 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.
Department of Neurology, University Hospital of Zürich, Switzerland. christine.kremer@nch.ma.uni-heidelberg.de
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Kremer
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Schaettin
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Georgiadis
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Baumgartner
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000209:etiology* / Q000517:prevention & control; D002539:Cerebral Arterial Diseases / Q000473:pathology*; D003251:Constriction, Pathologic; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D020767:Intracranial Thrombosis / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology*; D011379:Prognosis; D012307:Risk Factors
D005343:Fibrinolytic Agents