title: Impact of MCA stenosis on the early outcome in acute ischemic stroke patients.
abstract: BACKGROUND
  Asians have higher frequency of intracranial arterial stenosis. The present study aimed to compare the clinical features and outcomes of ischemic stroke patients with and without middle cerebral artery (MCA) stenosis, assessed by transcranial sonography (TCS), based on the Taiwan Stroke Registry (TSR).
  
  
  METHODS
  Patients with acute ischemic stroke or transient ischemic attack registered in the TSR, and received both carotid duplex and TCS assessment were categorized into those with stenosis (≥50%) and without (<50%) in the extracranial internal carotid artery (ICA) and MCA, respectively. Logistic regression analysis, Kaplan-Meier method and Cox proportional hazard model were applied to assess relevant variables between groups.
  
  
  RESULTS
  Of 6003 patients, 23.3% had MCA stenosis, 10.1% ICA stenosis, and 3.9% both MCA and ICA stenosis. Patients with MCA stenosis had greater initial NIHSS, higher likelihood of stroke-in-evolution, and more severe disability than those without (all p<0.001). Patients with MCA stenosis had higher prevalence of hypertension, diabetes and hypercholesterolemia. Patients with combined MCA and extracranial ICA stenosis had even higher NIHSS, worse functional outcome, higher risk of stroke recurrence or death (hazard ratio, 2.204; 95% confidence intervals, 1.440-3.374; p<0.001) at 3 months after stroke than those without MCA stenosis.
  
  
  CONCLUSIONS
  In conclusion, MCA stenosis was more prevalent than extracranial ICA stenosis in ischemic stroke patients in Taiwan. Patients with MCA stenosis, especially combined extracranial ICA stenosis, had more severe neurological deficit and worse outcome.
authors.affiliation: Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jiann-Shing
authors.initials: JS
authors.lastname: Jeng
authors.affiliation: School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
authors.forename: Fang-I
authors.initials: FI
authors.lastname: Hsieh
authors.affiliation: Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Hsu-Ling
authors.initials: HL
authors.lastname: Yeh
authors.affiliation: Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Wei-Hung
authors.initials: WH
authors.lastname: Chen
authors.affiliation: Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Hou-Chang
authors.initials: HC
authors.lastname: Chiu
authors.affiliation: Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Sung-Chun
authors.initials: SC
authors.lastname: Tang
authors.affiliation: Department of Neurology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chung-Hsiang
authors.initials: CH
authors.lastname: Liu
authors.affiliation: Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: Huey-Juan
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: Department of Neurology, E Da Hospital, Kaohsiung, Taiwan.
authors.forename: Shih-Pin
authors.initials: SP
authors.lastname: Hsu
authors.affiliation: Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yuk-Keung
authors.initials: YK
authors.lastname: Lo
authors.affiliation: Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
authors.forename: Lung
authors.initials: L
authors.lastname: Chan
authors.affiliation: Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Ruey-Tay
authors.initials: RT
authors.lastname: Lin
authors.affiliation: Department of Neurology, Landseed Hospital, Taoyuan, Taiwan.
authors.forename: Yu-Wei
authors.initials: YW
authors.lastname: Chen
authors.affiliation: Department of Neurology, Tri-Service General Hospital, Taipei, Taiwan.
authors.forename: Jiunn-Tay
authors.initials: JT
authors.lastname: Lee
authors.affiliation: Department of Neurology, Yuan Rung Hospital, Yuanlin Township, Changhua, Taiwan.
authors.forename: Chung-Hsin
authors.initials: CH
authors.lastname: Yeh
authors.affiliation: Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan.
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Sun
authors.affiliation: Department of Neurology, Cheng-Hsin General Hospital, Taipei, Taiwan.
authors.forename: Ta-Chang
authors.initials: TC
authors.lastname: Lai
authors.affiliation: Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Mu-Chien
authors.initials: MC
authors.lastname: Sun
authors.affiliation: Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Chen
authors.affiliation: Department of Neurology, Cathay General Hospital, Taipei, Taiwan.
authors.forename: Tsuey-Ru
authors.initials: TR
authors.lastname: Chiang
authors.affiliation: Department of Neurology, Buddhist Tzu Chi General Hospital Taipei Branch, New Taipei City, Taiwan.
authors.forename: Shinn-Kuang
authors.initials: SK
authors.lastname: Lin
authors.affiliation: Department of Neurology, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.
authors.forename: Bak-Sau
authors.initials: BS
authors.lastname: Yip
authors.affiliation: Department of Neurology, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan.
authors.forename: Chin-I
authors.initials: CI
authors.lastname: Chen
authors.affiliation: Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chi-Huey
authors.initials: CH
authors.lastname: Bai
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Sien-Tsong
authors.initials: ST
authors.lastname: Chen
authors.affiliation: School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chiou
authors.affiliation: Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan.|Department of Neurology, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Lien
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Chung Y
authors.initials: CY
authors.lastname: Hsu
mesh_terms: D000368:Aged; D003251:Constriction, Pathologic / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology*; D020521:Stroke / Q000473:pathology / Q000503:physiopathology*