Progression And Clinical Recurrence Of Middle Cerebral Artery Stenosis Or Occlusion And It's Risk Factors

ObjectiveWe conducted a study to determine which factors are associated with the progression of symptomatic middle cerebral artery (MCA) stenosis and to evaluate the relationship between progression and clinical recurrence. And assess the safety and feasibility of stent for patients with symptomatic middle cerebral artery stenosis (MCAS).Methods1. Sixty Patients that comfirmed for MCA stenosis from the June of 2005 to May of 2007 by a transcranial Doppler(TCD) scanner, the type of TC-8080 made in Nicolet Company in American, were reexamined with TCD scanning average 9.23±5.361 months after the first examination and any symptomatic cerebral vascular events were recorded during this period. Progression of the stenotic MCA were evaluated, based on the change of blood flow velocity in it between two examinations. At the same time, evaluate the relationship between progression and clinical recurrence.2. At the same time, six patients with symptomatic MCAS and used angioplast were enrolled in this study. Progression of the stenting MCA retenosis were evaluated, based on the change of blood flow velocity in it between two examinations and cerebral vascular events were recorded during this period.3. And, sixty-nine patients with MCAS and two hundreds and thirty six patients without MCA stenosis were enrolled to analyse the risk factors of MCA stenosis.Results:1. With a median follow-up of 9.23 months, 10 (16.67%) MCA stenoses progressed, 18 (30%) regressed, and 32 (53.33%) remained stable. There was no factor significantly associated with a lower progression rate in univariate analysis. A new ischemic event or vascular event during follow-up in the territory supplied by the stenosed MCA occurred in 8 cases (20%), 4 (50%) MCA stenoses progressed, 4 (50%) remained stable and no in regressed. Progression of the MCA stenosis detected by TCD was independently associated with a new ipsilateral ischemic event (P=0.0079, OR 2.126, 95%CI 1.219 to 3.708). But MCA stenosis degree has no significant correlation with a new ipsilateral ischemic event (P=0.403).2. There was no evident complication happened in all six patients during surgery, and the blood flow velocity became normal after surgery. With a median follow-up of nine months, four stenting vessles were restenosis, and there was only one patient had recurrent transient ischemic attake(TIA).3. Age, gender, hypertension, hyperlipidemia, family history of stroke, smoking and alcohol were significant higher in MCAS(P<0.05 or P<0.01)in univariable analysis, and family history of stroke (OR=3.230, P=0.0006, 95%CI 1.648-6.330), smoking (OR=4.057, P<0.0001, 95%CI 2.272-7.245) were had positive correlation with MCAS in Logistic regression analysis.Conclusions1. Progression of symptomatic MCA stenosis detected by means of TCD predicts clinical recurrence. Most of the prognosis of stenosis or occlusion of MCAs remains stable (53.3%) after treatment, part of the occlusive MCA could became severe stenosis, while part stenosis of MCAs could become occlusion., more regardence, should give to them.. Progression of the MCA stenosis detected by TCD was independently associated with a new ipsilateral ischemic event, but has no significant correlation with MCA stenosis degree.2. Age, gender, hypertension, hyperlipidemia, family history of stroke, smoking and alcohol were risk foctors of MCAS, and family history of stroke, smoking were had positive correlation with MCAS in Logistic regression analysis.