Symptomatic Middle Cerebral Artery Stenosis and Occlusion: Comparison of Three-dimensional Time-of-Flight Magnetic Resonance Angiography with Conventional Angiography

Sawada, Michio; Yano, Hirohito; Shinoda, Jun; Funakoshi, Takashi; Kumagai, Morio

doi:10.2176/nmc.34.682

Cited by 10 publications

(8 citation statements)

References 8 publications

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“…In terms of intracranial arterial stenosis, MRA sensitivity and specificity were reported to be 85-100% and 96-97%, respectively, when conventional contrast angiography was used as the diagnostic standard (30)(31)(32). MRA is hence considered a good alternative to conventional angiography.…”

Section: Discussionmentioning

confidence: 99%

Associations of Brachial-Ankle Pulse Wave Velocity and Carotid Atherosclerotic Lesions with Silent Cerebral Lesions

Matsumoto

Inoue

Moriki³

2007

Hypertens Res

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Section: Discussionmentioning

confidence: 99%

Associations of Brachial-Ankle Pulse Wave Velocity and Carotid Atherosclerotic Lesions with Silent Cerebral Lesions

Matsumoto

Inoue

Moriki³

2007

Hypertens Res

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“…Although non‐invasive detection of isolated symptomatic MCA stenosis through both MRA and TCCS can provide accurate assessment of vascular lesions, after which risk factor reduction or prophylactic intervention can be undertaken (Toole, 1987; Sawada et al. , 1994), the secondary prevention of stroke in this special group of patients remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Although non-invasive detection of isolated symptomatic MCA stenosis through both MRA and TCCS can provide accurate assessment of vascular lesions, after which risk factor reduction or prophylactic intervention can be undertaken (Toole, 1987;Sawada et al, 1994), the secondary prevention of stroke in this special group of patients remains controversial. The operation of extracranial-intracranial (EC-IC) artery anastomosis has been used for patients with MCA stenosis, yet there is little data on the natural history of this condition against which to assess the benefit of the operation (Yonekura et al, 1982;Dorfmuller et al, 1992).…”

Section: Discussionmentioning

confidence: 99%

“…Revived interest in symptomatic MCA stenosis and the desire to ascertain its presence arise from new diagnostic techniques, particularly three‐dimensional time‐of‐flight (3‐D TOF) magnetic resonance angiogram (MRA) and transcranial color‐coded sonography (TCCS), which both are useful non‐invasive diagnostic methods for evaluating occlusive lesions of the MCA in symptomatic patients, after which risk factor reduction or prophylactic intervention can be undertaken (Sawada et al. , 1994; Kimura et al.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic factors and therapeutic outcome of isolated symptomatic middle cerebral artery stenosis

Tsai

Chang

et al. 2005

Euro J of Neurology

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To analyze the prognostic factors and therapeutic outcome of adult patients with isolated symptomatic stenosis of the middle cerebral artery (MCA). Forty-nine patients were retrospectively verified with isolated symptomatic stenosis of the MCA through both magnetic resonance angiogram and transcranial color-coded duplex sonography. Therapeutic outcome at 1 year or more was determined using a modified Barthel index (BI). For the purpose of analysis, the patients were divided into two groups: a good outcome group (BI > or = 12) and a poor outcome group (BI < 12 or recurrent stroke). The association between different therapeutic regimens and the percent free of recurrent stroke after the first event of cerebral infarction was assessed with Kaplan-Meier plots compared by a log-rank test. These patients accounted for 2.8% of all patients with the first event of cerebral infarction during the same period. At follow-up of 1 year or more, 63% had good outcomes whilst the other 37% had poor outcomes. Overall, 26.5% suffered from recurrent strokes during the follow-up period. According to the statistical analysis, the stepwise logistic regression revealed that only the National Institutes of Health Stroke Scale (NIHSS) at the time of admission was independently associated with a poor outcome. Furthermore, Kaplan-Meier analysis showed a significantly higher percentage of patients free of recurrent stroke events amongst those who were treated with warfarin. The NIHSS at the time of admission was a predictor of outcome amongst our patients, and stenosis of the MCA implies the danger of recurrent cerebral events. Our study also demonstrates the efficacy of oral anticoagulants in the secondary prevention in this specific group of patients. Therefore, we look forward to more prospective multicenter investigations in evaluating the efficiency of therapy in the future.

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“…TOF MRA was first compared with DSA in the 1990s, showing up to 100% detection of intracranial artery occlusion. 48,49 Since then, this technique has rapidly emerged as a common means of imaging the intracranial arteries noninvasively without using gadolinium; TOF MRA takes advantage of the contrast between nonsaturated spins in the blood entering the imaging plane and the stationary adjacent tissue, which remains saturated.…”

Section: Mramentioning

confidence: 99%

MR Angiography and Imaging for the Evaluation of Middle Cerebral Artery Atherosclerotic Disease

Degnan

Gallagher

Zhang

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY:Intracranial atherosclerotic disease may constitute the most common cause of ischemic stroke worldwide; yet, in the developed world, imaging research has largely focused on extracranial atherosclerosis. Many studies in populations of Asian, African, and Hispanic descent demonstrate the preponderance of intracranial stenosis compared with carotid stenosis. This review examines the clinical presentations of MCA atherosclerosis and stenosis and the use of noninvasive MR imaging in the assessment of intracranial vasculature. MRA is a well-validated technique that offers great advantage over traditional angiography. Advances in high-resolution MR imaging of MCA stenosis have the potential to yield excellent visualization of plaque. Future developments in high-resolution MR imaging to depict intracranial atherosclerosis are explored in this review; these advances will guide endovascular therapy and the comparison of novel interventions.ABBREVIATIONS: TOF ϭ time-of-flight; TCD ϭ transcranial Doppler S troke is a common cause of morbidity and mortality, with cerebrovascular disease constituting the second most frequent cause of death worldwide.1 While the burden of cerebrovascular disease in the developing world is receiving greater attention, its importance is underestimated.2 Intracranial atherosclerotic disease is reaching greater clinical prominence as potentially the greatest contributor to the burden of cerebrovascular disease worldwide.3 Previously, atherosclerotic disease within intracranial vessels was not well-appreciated clinically, perhaps due to the inability to visualize the MCA noninvasively or the greater emphasis on the more easily imaged carotid arteries. In an early study of MCA syndromes, Lhermitte et al 4 alleged that "atherosclerotic thrombosis of MCA is probably a rare event and the primary cause . . . lies in the proximal ICA . . . for an almost inaccessible artery appears to be of little significance." Thus, early investigations established a precedent of emphasizing extracranial atherosclerosis at the expense of investigation of other manifestations of cerebrovascular disease.In examining only extracranial disease, investigators may be detecting only advanced atherosclerosis. Some argue that MCA disease may precede extracranial atherosclerosis; this sequence is suggested by the lack of substantial carotid stenosis in a group of patients with intracranial atherosclerosis, while nearly all those with extracranial stenosis also had concomitant intracranial stenosis.5 Therefore, detecting intracranial atherosclerosis may enable clinicians to intervene earlier.There is much controversy about the degree of MCA stenosis responsible for stroke, with some groups arguing that MCA stenosis is not important in the white population on the basis of a small TCD sonography study.6 Yet a host of postmortem and imaging studies implicate MCA atherosclerosis as a likely cause of stroke.7-9 Further investigation is necessary to evaluate the prevalence and importance of MCA disease as an etiology of ischemic...

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Symptomatic Middle Cerebral Artery Stenosis and Occlusion: Comparison of Three-dimensional Time-of-Flight Magnetic Resonance Angiography with Conventional Angiography

Cited by 10 publications

References 8 publications

Associations of Brachial-Ankle Pulse Wave Velocity and Carotid Atherosclerotic Lesions with Silent Cerebral Lesions

Associations of Brachial-Ankle Pulse Wave Velocity and Carotid Atherosclerotic Lesions with Silent Cerebral Lesions

Prognostic factors and therapeutic outcome of isolated symptomatic middle cerebral artery stenosis

MR Angiography and Imaging for the Evaluation of Middle Cerebral Artery Atherosclerotic Disease

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