Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Apr 7;12(4):e0175434.
doi: 10.1371/journal.pone.0175434. eCollection 2017.

Impact of MCA stenosis on the early outcome in acute ischemic stroke patients

Jiann-Shing Jeng  1 , Fang-I Hsieh  2 , Hsu-Ling Yeh  3 , Wei-Hung Chen  3 , Hou-Chang Chiu  3 , Sung-Chun Tang  1 , Chung-Hsiang Liu  4 , Huey-Juan Lin  5 , Shih-Pin Hsu  6 , Yuk-Keung Lo  7 , Lung Chan  8 , Chih-Hung Chen  9 , Ruey-Tay Lin  10 , Yu-Wei Chen  11 , Jiunn-Tay Lee  12 , Chung-Hsin Yeh  13 , Ming-Hui Sun  14 , Ta-Chang Lai  15 , Yu Sun  16 , Mu-Chien Sun  17 , Po-Lin Chen  18 , Tsuey-Ru Chiang  19 , Shinn-Kuang Lin  20 , Bak-Sau Yip  21 , Chin-I Chen  22 , Chi-Huey Bai  23 , Sien-Tsong Chen  24 , Hung-Yi Chiou  2 , Li-Ming Lien  3   25 , Chung Y Hsu  26 ; Taiwan Stroke Registry Investigators
Affiliations

Impact of MCA stenosis on the early outcome in acute ischemic stroke patients

Jiann-Shing Jeng et al. PLoS One. .

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.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Cumulative survival (free of recurrent stroke or death) among patients with or without MCA stenosis.
See this image and copyright information in PMC

References

    1. Wong KS. Global burden of intracranial atherosclerosis. International journal of stroke. 2006; 1(3): 158–9. 10.1111/j.1747-4949.2006.00045.x - DOI - PubMed
    1. Battistella V, Elkind M. Intracranial atherosclerotic disease. European journal of neurology. 2014; 21(7):956–62. 10.1111/ene.12385 - DOI - PubMed
    1. Qureshi AI, Caplan LR. Intracranial atherosclerosis. Lancet. 2014; 383(9921): 984–98. 10.1016/S0140-6736(13)61088-0 - DOI - PubMed
    1. Jeng JS, Tang SC, Liu HM. Epidemiology, diagnosis and management of intracranial atherosclerotic disease. Expert review of cardiovascular therapy. 2010; 8(10): 1423–32. 10.1586/erc.10.129 - DOI - PubMed
    1. Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. The New England journal of medicine. 2005; 352(13): 1305–16. 10.1056/NEJMoa043033 - DOI - PubMed