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

Jiann‐Shing Jeng ,Lung Chan,Yu Sun,Chung Y Hsu,Bak-Sau Yip,Hung Yi Chiou ,Chin I Chen ,Li Ming Lien ,Po‐Lin Chen ,Tsuey Ru Chiang ,Shih Pin Hsu ,Ming Sun ,Fang I Hsieh ,Chi Huey Bai ,Huey Juan Lin ,Wei Hung Chen ,Mu Chien Sun ,Chung Hsiang Liu ,Sung‐Chun Tang ,Ruey Tay Lin ,Shinn Kuang Lin ,Hsu Ling Yeh ,Sien Tsong Chen ,Jiunn Tay Lee ,Hou Chang Chiu ,Ta Chang Lai ,Chih‐Hung Chen ,Yu Wei Chen ,Yuk Keung Lo ,Chung Hsin Yeh

doi:10.1371/journal.pone.0175434

Abstract

BackgroundAsians 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).MethodsPatients 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.ResultsOf 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.ConclusionsIn 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.

Highlights

Intracranial arterial stenosis (ICAS) is increasingly recognized as an important factor in defining stroke subtypes and in selecting preventive or therapeutic measures [1,2,3,4,5,6]
Patients with combined middle cerebral artery (MCA) and extracranial internal carotid artery (ICA) stenosis had even higher National Institute of Health Stroke Scale (NIHSS), worse functional outcome, higher risk of stroke recurrence or death at 3 months after stroke than those without MCA stenosis
MCA stenosis was more prevalent than extracranial ICA stenosis in ischemic stroke patients in Taiwan

Summary

Introduction

Intracranial arterial stenosis (ICAS) is increasingly recognized as an important factor in defining stroke subtypes and in selecting preventive or therapeutic measures [1,2,3,4,5,6]. Patients with symptomatic ICAS may have a higher risk of recurrent stroke [1,2,3,4,5,6,7]. ICAS is noted in 5% to 10% of Caucasians patients with ischemic strokes [10,15,16,17,18,19], but in 28% to 54% in Asian counterparts [11,12,13,14]. In Chinese patients with ischemic stroke, the middle cerebral artery (MCA) was the most commonly identified location of ICAS [19]. 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

Results

Conclusion