Outcome of middle cerebral artery territory stroke without recanalization therapy in a tertiary care hospital of Bangladesh

Subash Kanti Dey,Ashish Chowdhury,Abu Nasir Rizvi,Mst Habiba Khatun,Anis Ahmed,Md Ahsan Habib,Md Shahidullah

doi:10.3329/bsmmuj.v14i3.56602

Abstract

Among all the large vessel territory stroke, middle cerebral artery (MCA) territory stroke is the most common . Outcome depends on awareness and availability of specific treatment and proper conservative management after stroke. This prospective cohort study enrolled 49 clinically and radiologically diagnosed MCA territory stroke patients admitted in Neurology Department of Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2018 to December 2020. The aim was to see the prognosis of the middle cerebral artery territory (MCA) stroke patient who were treated conservatively. The Modified Rankin Scale (mRS) was used to measure the prognosis just after admission, after three months, six months, one year and two years; and the mean scores were 3.88 ± 0.88, 3.33 ± 1.24, 2.98 ± 1.42, 2.67 ± 1.60 & 2.23 ± 1.56 respectively. Among 49 patients, 9 patients died over the study period; one patient within one month after stroke, 3 patients within 3 months and 5 patients within six months. Though death rate was high in first three months, the survived patients improved significantly with conservative management in next two years of follow-up period. BSMMU J 2021; 14(3): 74-78

Highlights

Large territory middle cerebral artery strokes are devastating events that result in high rates of disability and death
Intravenous recombinant tissue plasminogen activator (IV-rtPA) i.e. Alteplase is approved for the treatment of acute ischaemic stroke
The combined treatment with stent retriever mechanical thrombectomy (MT) devices and IV-rtPA within 6 hours after stroke onset is superior to standard medical therapy for acute ischemic stroke caused by a proximal large artery occlusion of the anterior circulation.[4]

Summary

Introduction

Large territory middle cerebral artery strokes are devastating events that result in high rates of disability and death. The combined treatment with stent retriever mechanical thrombectomy (MT) devices and IV-rtPA within 6 hours after stroke onset is superior to standard medical therapy (with IV-rtPA alone) for acute ischemic stroke caused by a proximal large artery occlusion of the anterior circulation.[4]. Intravenous rtPA is able to recanalize in approximate 1/3 of the patients.[9]. This may explain the limited efficacy in these patients. Studies revealed that combination of rapid endovascular therapy and intravenous thrombolysis showed increased rate of recanalization and the improvement of clinical outcomes in patients with acute stroke from major artery occlusion.[10-12]. Due to lack of awareness and availability of the specific treatment, most of the patients can not avail the treatment.

Objectives

Methods

Results

Conclusion