PLoS ONE (Jan 2017)

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

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

DOI
https://doi.org/10.1371/journal.pone.0175434
Journal volume & issue
Vol. 12, no. 4
p. e0175434

Abstract

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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.