Prognosis of symptomatic and asymptomatic middle cerebral artery occlusion.
BACKGROUND
The annual risk of stroke or cardiovascular events has been reported to be over 10% in middle cerebral artery stenosis. However, the prognosis of patients with middle cerebral artery occlusion (MCAO) remains unclear. We investigated the risk of cardiovascular events or death in patients with symptomatic or asymptomatic MCAO.


METHODS
Consecutive patients with MCAO demonstrated by transcranial Doppler sonography and magnetic resonance angiography were enrolled. Medical records were reviewed during the follow-up period and a telephone interview was conducted using a preformed questionnaire, comparing asymptomatic and symptomatic patients who had a history of ischemic stroke or transient ischemic attack in the same vascular territory. The composite outcome of ipsilateral stroke, hemorrhagic stroke, overall stroke, myocardial infarction (MI), any vascular death and nonvascular death was evaluated during the follow-up period.


RESULTS
Thirty-seven of the 48 patients were symptomatic and 11 were asymptomatic. During the mean follow-up period of 2.8 years, cardiovascular events or death occurred in a total of 13 patients: 1 from the asymptomatic group and 12 from the symptomatic group (overall stroke, 6; MI, 2; vascular death, 1; nonvascular death, 5). The annual rates of composite outcome (2.2 vs. 13.2%, p = 0.041) and overall stroke (0.0 vs. 6.6%, p = 0.048) were significantly lower in the asymptomatic group.


CONCLUSIONS
These results suggest that the overall prognosis of MCAO is not worse than previously reported for patients with middle cerebral artery stenosis or internal carotid artery stenosis. Asymptomatic MCAO seems to be a benign condition associated with a low risk of subsequent stroke, MI or death under the optimal medical therapy.
Kang
Bong-Su
BS
Department of Neurology, Seoul National University and Seoul National University Boramae Hospital, Seoul, South Korea.
Kwon
Hyung-Min
HM
Ryu
Wi-Sun
WS
Lee
Yong-Seok
YS
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000401:mortality / Q000473:pathology; D002546:Ischemic Attack, Transient / Q000209:etiology; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011379:Prognosis; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial