Symptomatic middle cerebral artery stenosis treated with intracranial angioplasty: experience in 32 patients.

Abstract

To retrospectively review the outcome after angioplasty in patients with symptomatic, high-grade middle cerebral artery (MCA) stenosis refractory to medical therapy. Institutional review board approval to perform angioplasty procedures for MCA stenosis was obtained, and written informed consent was obtained from each patient or the patient's family. Institutional review board approval was also obtained for the retrospective review of patients' data. The institutional review board waived the need for informed consent for this retrospective analysis.Thirty-two consecutive patients (18 men, 14 women; median age, 55 years) with symptomatic MCA stenosis greater than 70% underwent angioplasty between June 1994 and July 2003. The indication for angioplasty was recurrent transient ischemic attack (TIA) refractory to antithrombotic therapy in 24 patients and acute ischemic stroke in eight. Patient records were retrospectively reviewed for angiographic findings, periprocedural complications, and follow-up data. Angioplasty reduced the degree of stenosis to less than 50% in 29 of 32 patients (91%). There were two major complications during angioplasty: acute occlusion of the treated MCA and vascular rupture that resulted in death. Thus, the risk of disabling stroke or death was 6% (two of 32 patients), and the mortality rate was 3% (one of 32 patients). The rate of periprocedural TIA was 19% (six of 32 patients). Five patients had asymptomatic intimal dissection. During the follow-up period, which ranged from 5 to 92 months (median, 20 months), TIA occurred in one patient in whom the results of angioplasty were suboptimal. The remaining 29 patients did not experience further ischemic events attributable to the treated MCA stenosis during the follow-up period. Asymptomatic restenosis occurred in one of five patients in whom data from follow-up angiography were available. MCA angioplasty resulted in a low recurrence rate of ischemic symptoms during long-term follow-up.