Purpose: Little is known about the long term clinical outcomes of middle cerebral artery (MCA) stenosis / occlusion patients who are treated with medical therapy. The efficacy and safety of the medical treatment was evaluated by analyzing the clinical outcomes along and imaging analysis using CT Angiography (CTA) with an automatic measurement software.
Methods: Patients who were diagnosed with middle artery stenosis or occlusion were prospectively enrolled in the study. Those who were diagnosed with moyamoya disease were excluded. Along with the rigorous medical treatment for atherosclerosis risk factors, Cilostazol 200mg/day was selected as the first line of medication, and switched to either aspirin 100mg/day or clopidogrel 75mg/day if necessary. CT Angiogram (CTA) was performed and a software for the measurement of stenosis on the stretched view was used for evaluating the degree of stenosis. The neurological findings as well as the degree of stenosis during the observation time were analyzed.
Results: Of the 186 MCA stenosis / occlusion patients who visited our institution, 62 lesions in 60 patients who completed periodic CTA evaluation were selected for the study. 20 lesions (40.3%) were symptomatic at the time of diagnosis. 45 patients (75.0%) were treated with cilostazol and 22 (36.7%) underwent dual antiplatelet therapy. 7 patients (11.7%) were observed without any antiplatelet therapy. During the median observation time of 75.6 months, 24 patients (40.0%) showed angiographic improvement, and the median % area stenosis improved from 66.0% (IQR: 53.0 - 80.0) to 54.7% (48.6 - 77.5). Of the 29 patients who showed complete occlusion at the initial diagnosis, 17 (58.6%) showed any degree of recanalization. For those with symptomatic lesions, no patient developed major stroke on the ipsilateral side after completing the 3 months of initial treatment.
Conclusions: Angiographic improvement of MCA stenosis was observed with successful prevention of major stroke associated with the disease. Majority of the patients who tolerated the complete occlusion at the time of initial treatment showed recanalization during the observation period. Medical treatment can be an effective therapeutic method for the MCA stenosis / occlusion patients.