Progression and clinical recurrence of symptomatic middle cerebral artery stenosis - A long-term follow-up transcranial Doppler ultrasound study

Background and Purpose-Patients with symptomatic intracranial atherosclerot ic stenosis have a high rate of recurrence. We conducted a prospective stud y to determine which factors are associated with the progression of symptom atic middle cerebral artery (MCA) stenosis and to evaluate the relationship between progression and clinical recurrence. Methods-Between January 1996 and February 2000, of a total of 2564 consecut ive first-ever transient ischemic attack (TIA) or stroke patients admitted to Our cerebrovascular unit, 145 showed an MCA stenosis signal on transcran ial Doppler (TCD) on admission, and 40 fulfilled all criteria to enter this study, including angiographic confirmation. Patients were prescribed antip latelet or anticoagulant agents following the criteria of the neurologist i n charge. TCD recordings and clinical interviews were performed regularly d uring follow-up. Progression of MCA stenosis was defined as an increase > 3 0 cm/s in TCD-recorded maximum mean flow velocity. Logistic regression anal yses were used to identify predictors of progression and clinical recurrenc e. Results-With a median follow-up of 26.55 months, 13 (32.5%) MCA stenoses pr ogressed. 3 (7.5%) regressed, and 24 (60%) remained stable. Absence of sign ificant extracranial internal carotid artery (ICA) stenosis (P=0.049) and t he use of oral anticoagulants (P=0.045) were significantly associated with a lower progression rate in univariate analysis, and anticoagulation remain ed an independent predictor when a logistic regression model was applied (O R 7.25, CI 1.1 to 48.1. P=0.019). A new ischemic event during follow-up in the territory Supplied by the stenosed MCA occurred in 8 cases (20%). and 1 3 patients had a major vascular event. Progression of the MCA stenosis dete cted by TCD was independently associated with a new ipsilateral ischemic ev ent (OR 2.89, CI 1.09 to 7.71, P=0.031) and with the occurrence of any majo r vascular event (OR 7.03, CI 1.6 to 30.9, P=0.0071). Conclusions-Progression of symptomatic MCA stenosis detected by means of TC D predicts clinical recurrence. Anticoagulation is independently associated with a lower progression rate of symptomatic MCA stenosis.