RSS-Feed abonnieren
DOI: 10.1055/s-2005-871873
Middle Cerebral Artery Stenosis: Endovascular and Surgical Options
Publikationsverlauf
Publikationsdatum:
08. Juli 2005 (online)
![](https://www.thieme-connect.de/media/sbs/200503/lookinside/thumbnails/10.1055-s-2005-871873-1.jpg)
ABSTRACT
Atherosclerotic middle cerebral artery stenosis is a rare but potentially devastating cause of cerebral ischemia and stroke. While medical management remains the mainstay for stroke prevention, surgical and/or endovascular intervention is indicated in selected patients. This article reviews the role of surgery and endovascular techniques in the treatment of middle cerebral artery stenosis based on its natural history, pathophysiology, and prognosis when treated medically.
KEYWORDS
Middle cerebral artery stenosis - surgery - bypass - stenting - endovascular - angioplasty
REFERENCES
- 1 Mohr J P, Lazar R M, Marshall R S, Gautier J C, Hier D B. Middle cerebral artery disease. In: Barnett HJM, Mohr JP, Stein BM, Yatsu FM Stroke: Pathophysiology, Diagnosis, and Management New York, NY; Churchill Livingstone 1998: 427-479
- 2 Fisher C M. Cerebral ischemia-less familiar types. Clin Neurosurg. 1971; 18 267-336
- 3 Lhermitte F, Gautier J C, Derouesne C. Nature of occlusions of the middle cerebral artery. Neurology. 1970; 20 82-88
- 4 Hass W K, Fields W S, North R R, Kircheff I I, Chase N E, Bauer R B. Joint study of extracranial arterial occlusion. II. Arteriography, techniques, sites, and complications. JAMA. 1968; 203 961-968
- 5 Marzewski D J, Furlan A J, St Louis P, Little J R, Modic M T, Williams G. Intracranial internal carotid artery stenosis: longterm prognosis. Stroke. 1982; 13 821-824
- 6 Wong K S, Li H, Lam W W, Chan Y L, Kay R. Progression of middle cerebral artery occlusive disease and its relationship with further vascular events after stroke. Stroke. 2002; 33 532-536
- 7 Akins P T, Pilgram T K, Cross III D T, Moran C J. Natural history of stenosis from intracranial atherosclerosis by serial angiography. Stroke. 1998; 29 433-438
- 8 Caplan L R, Gorelick P B, Hier D B. Race, sex and occlusive cerebrovascular disease: a review. Stroke. 1986; 17 648-655
- 9 Prognosis of patients with symptomatic vertebral or basilar artery stenosis. The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study Group. Stroke. 1998; 29 1389-1392
- 10 Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. The EC/IC Bypass Study Group. N Engl J Med. 1985; 313 1191-1200
- 11 Hopkins L N, Martin N A, Hadley M N, Spetzler R F, Budny J, Carter L P. Vertebrobasilar insufficiency. Part 2. Microsurgical treatment of intracranial vertebrobasilar disease. J Neurosurg. 1987; 66 662-674
- 12 Bogousslavsky J, Barnett H J, Fox A J, Hachinski V C, Taylor W. Atherosclerotic disease of the middle cerebral artery. Stroke. 1986; 17 1112-1120
- 13 Caplan L, Babikian V, Helgason C et al.. Occlusive disease of the middle cerebral artery. Neurology. 1985; 35 975-982
- 14 Webster M W, Makaroun M S, Steed D L, Smith H A, Johnson D W, Yonas H. Compromised cerebral blood flow reactivity is a predictor of stroke in patients with symptomatic carotid artery occlusive disease. J Vasc Surg. 1995; 21 338-344
- 15 Heyden S, Heyman A, Goree J A. Nonembolic occlusion of the middle cerebral and carotid arteries-a comparison of predisposing factors. Stroke. 1970; 1 363-369
- 16 Shin Y S, Kim S Y, Bang O Y et al.. Early experiences of elective stenting for symptomatic stenosis of the M1 segment of the middle cerebral artery: reports of three cases and review of the literature. J Clin Neurosci. 2003; 10 53-59
- 17 Arenillas J F, Molina C A, Montaner J, Abilleira S, Gonzalez-Sanchez M A, Alvarez-Sabin J. Progression and clinical recurrence of symptomatic middle cerebral artery stenosis: a long-term follow-up transcranial Doppler ultrasound study. Stroke. 2001; 32 2898-2904
- 18 Feldmann E, Daneault N, Kwan E et al.. Chinese-White differences in the distribution of occlusive cerebrovascular disease. Neurology. 1990; 40 1541-1545
- 19 Lyrer P A, Engelter S, Radu E W, Steck A J. Cerebral infarcts related to isolated middle cerebral artery stenosis. Stroke. 1997; 28 1022-1027
- 20 Segura T, Serena J, Castellanos M, Teruel J, Vilar C, Davalos A. Embolism in acute middle cerebral artery stenosis. Neurology. 2001; 56 497-501
- 21 Adams Jr H P, Gross C E. Embolism distal to stenosis of the middle cerebral artery. Stroke. 1981; 12 228-229
- 22 Hinton R C, Mohr J P, Ackerman R H, Adair L B, Fisher C M. Symptomatic middle cerebral artery stenosis. Ann Neurol. 1979; 5 152-157
- 23 Kremer C, Schaettin T, Georgiadis D, Baumgartner R W. Prognosis of asymptomatic stenosis of the middle cerebral artery. J Neurol Neurosurg Psychiatry. 2004; 75 1300-1303
- 24 Becker V U, Eckert B, Thie A. Isolated symptomatic stenosis of the middle cerebral artery in younger adults. A clinical and ultrasonic follow-up study of eight patients. Eur Neurol. 1996; 36 65-70
- 25 Corston R N, Kendall B E, Marshall J. Prognosis in middle cerebral artery stenosis. Stroke. 1984; 15 237-241
- 26 Schmiedek P, Piepgras A, Leinsinger G, Kirsch C M, Einhupl K. Improvement of cerebrovascular reserve capacity by EC-IC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia. J Neurosurg. 1994; 81 236-244
- 27 Schick U, Zimmermann M, Stolke D. Long-term evaluation of EC-IC bypass patency. Acta Neurochir (Wien). 1996; 138 938-942
- 28 Kleiser B, Widder B. Course of carotid artery occlusions with impaired cerebrovascular reactivity. Stroke. 1992; 23 171-174
- 29 Yonas H, Smith H A, Durham S R, Pentheny S L, Johnson D W. Increased stroke risk predicted by compromised cerebral blood flow reactivity. J Neurosurg. 1993; 79 483-489
- 30 Walker M T, Deshmukh S, Harbison D L, Partovi S. CT perfusion imaging. BNI Q. 2001; 17 15-27
- 31 Charbel F T, Zhao M, Amin-Hanjani S, Hoffman W, Du X, Clark M E. A patient-specific computer model to predict outcomes of the balloon occlusion test. J Neurosurg. 2004; 101 977-988
- 32 Amin-Hanjani S, Du X, Mlinarevich N, Meglio G, Zhao M, Charbel F T. The cut flow index: an intraoperative predictor of the success of extracranial-intracranial bypass for occlusive cerebrovascular disease. Neurosurgery. 2005; 56 75-85
- 33 Wanebo J E, Zabramski J M, Spetzler R F. Superficial temporal artery-to-middle cerebral artery bypass grafting for cerebral revascularization. Neurosurgery. 2004; 55 395-398
- 34 Newell D W, Vilela M D. Superficial temporal artery to middle cerebral artery bypass. Neurosurgery. 2004; 54 1441-1448
- 35 Spetzler R F, Roski R A, Rhodes R S, Modic M T. The “bonnet bypass.” Case report. J Neurosurg. 1980; 53 707-709
- 36 Mendelowitsch A, Taussky P, Rem J A, Gratzl O. Clinical outcome of standard extracranial-intracranial bypass surgery in patients with symptomatic atherosclerotic occlusion of the internal carotid artery. Acta Neurochir (Wien). 2004; 146 95-101
- 37 Nussbaum E S, Erickson D L. Extracranial-intracranial bypass for ischemic cerebrovascular disease refractory to maximal medical therapy. Neurosurgery. 2000; 46 37-42
- 38 Weinstein P R, Baena R, Chater N L. Results of extracranial-intracranial arterial bypass for intracranial internal carotid artery stenosis: review of 105 cases. Neurosurgery. 1984; 15 787-794
- 39 Ishikawa T, Houkin K, Kamiyama H, Abe H. Effects of surgical revascularization on outcome of patients with pediatric moyamoya disease. Stroke. 1997; 28 1170-1173
- 40 Isono M, Ishii K, Kamida T, Inoue R, Fujiki M, Kobayashi H. Long-term outcomes of pediatric moyamoya disease treated by encephalo-duro-arterio-synangiosis. Pediatr Neurosurg. 2002; 36 14-21
- 41 Kinugasa K, Mandai S, Kamata I, Sugiu K, Ohmoto T. Surgical treatment of moyamoya disease: operative technique for encephalo-duro-arterio-myo-synangiosis, its follow-up, clinical results, and angiograms. Neurosurgery. 1993; 32 527-531
- 42 Robertson R L, Burrows P E, Barnes P D, Robson C D, Poussaint T Y, Scott R M. Angiographic changes after pial synangiosis in childhood moyamoya disease. AJNR Am J Neuroradiol. 1997; 18 837-845
- 43 Nakashima H, Meguro T, Kawada S, Hirotsune N, Ohmoto T. Long-term results of surgically treated moyamoya disease. Clin Neurol Neurosurg. 1997; 99(Suppl 2) S156-S161
- 44 Andrews B T, Chater N L, Weinstein P R. Extracranial-intracranial arterial bypass for middle cerebral artery stenosis and occlusion. Operative results in 65 cases. J Neurosurg. 1985; 62 831-838
- 45 Vorstrup S, Brun B, Lassen N A. Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery. Stroke. 1986; 17 1291-1298
- 46 McCormick P W, Tomecek F J, McKinney J, Ausman J I. Disabling cerebral transient ischemic attacks. J Neurosurg. 1991; 75 891-901
- 47 Holzschuh M, Brawanski A, Ullrich W, Meixensberger J. Cerebral blood flow and cerebrovascular reserve 5 years after EC-IC bypass. Neurosurg Rev. 1991; 14 275-278
- 48 Powers W J, Grubb R L, Raichle M E. Clinical results of extracranial-intracranial bypass surgery in patients with hemodynamic cerebrovascular disease. J Neurosurg. 1989; 70 61-67
- 49 Anderson D E, McLane M P, Reichman O H, Origitano T C. Improved cerebral blood flow and CO2 reactivity after microvascular anastomosis in patients at high risk for recurrent stroke. Neurosurgery. 1992; 31 26-33
- 50 Schmiedek P. EC-IC bypass in hemodynamic cerebrovascular disease [comment]. J Neurosurg. 1989; 71 464-465
- 51 Schmiedek P. Long-term evaluation of EC-IC bypass patency [comment]. Acta Neurochir (Wien). 1996; 138 942
- 52 Lee J H, Kwon S U, Lee J H, Suh D C, Kim J S. Percutaneous transluminal angioplasty for symptomatic middle cerebral artery stenosis: long-term follow-up. Cerebrovasc Dis. 2003; 15 90-97
- 53 Marks M P, Marcellus M, Norbash A M, Steinberg G K, Tong D, Albers G W. Outcome of angioplasty for atherosclerotic intracranial stenosis. Stroke. 1999; 30 1065-1069
- 54 Mori T, Fukuoka M, Kazita K, Mori K. Follow-up study after intracranial percutaneous transluminal cerebral balloon angioplasty. AJNR Am J Neuroradiol. 1998; 19 1525-1533
- 55 Suh D C, Sung K B, Cho Y S et al.. Transluminal angioplasty for middle cerebral artery stenosis in patients with acute ischemic stroke. AJNR Am J Neuroradiol. 1999; 20 553-558
- 56 Jiang W J, Wang Y J, Du B et al.. Stenting of symptomatic M1 stenosis of middle cerebral artery: an initial experience of 40 patients. Stroke. 2004; 35 1375-1380
- 57 Kim J K, Ahn J Y, Lee B H et al.. Elective stenting for symptomatic middle cerebral artery stenosis presenting as transient ischaemic deficits or stroke attacks: short term arteriographical and clinical outcome. J Neurol Neurosurg Psychiatry. 2004; 75 847-851
- 58 Gomez C R, Misra V K, Campbell M S, Soto R D. Elective stenting of symptomatic middle cerebral artery stenosis. AJNR Am J Neuroradiol. 2000; 21 971-973
- 59 Sundt Jr T M, Smith H C, Campbell J K, Vlietstra R E, Cucchiara R F, Stanson A W. Transluminal angioplasty for basilar artery stenosis. Mayo Clin Proc. 1980; 55 673-680
- 60 Connors III J J, Wojak J C. Percutaneous transluminal angioplasty for intracranial atherosclerotic lesions: evolution of technique and short-term results. J Neurosurg. 1999; 91 415-423
- 61 Nakano S, Yokogami K, Ohta H, Yano T, Ohnishi T. Direct percutaneous transluminal angioplasty for acute middle cerebral artery occlusion. AJNR Am J Neuroradiol. 1998; 19 767-772
- 62 Touho H. Percutaneous transluminal angioplasty in the treatment of atherosclerotic disease of the anterior cerebral circulation and hemodynamic evaluation. J Neurosurg. 1995; 82 953-960
- 63 Takis C, Kwan E S, Pessin M S, Jacobs D H, Caplan L R. Intracranial angioplasty: experience and complications. AJNR Am J Neuroradiol. 1997; 18 1661-1668
- 64 Tsai F Y, Berberian B, Matovich V, Lavin M, Alfieri K. Percutaneous transluminal angioplasty adjunct to thrombolysis for acute middle cerebral artery rethrombosis. AJNR Am J Neuroradiol. 1994; 15 1823-1829
- 65 Jimenez C, Duong H, Olarte M, Pile-Spellman J. Recurrent abrupt occlusion after transluminal angioplasty for basilar artery stenosis: case report. Neurosurgery. 1999; 44 210-215
- 66 McKenzie J D, Wallace R C, Dean B L, Flom R A, Khayata M H. Preliminary results of intracranial angioplasty for vascular stenosis caused by atherosclerosis and vasculitis. AJNR Am J Neuroradiol. 1996; 17 263-268
- 67 Kimura T, Yokoi H, Nakagawa Y et al.. Three-year follow-up after implantation of metallic coronary-artery stents. N Engl J Med. 1996; 334 561-566
- 68 Huang P, Levin T, Kabour A, Feldman T. Acute and late outcome after use of 2.5-mm intracoronary stents in small (< 2.5 mm) coronary arteries. Catheter Cardiovasc Interv. 2000; 49 121-126
- 69 Han P P, Albuquerque F C, Ponce F A et al.. Percutaneous intracranial stent placement for aneurysms. J Neurosurg. 2003; 99 23-30
- 70 Benitez R P, Silva M T, Klem J, Veznedaroglu E, Rosenwasser R H. Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery. 2004; 54 1359-1367
- 71 Fiorella D, Albuquerque F C, Han P, McDougall C G. Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. Neurosurgery. 2004; 54 6-16
- 72 Feldman R L, Trigg L, Gaudier J, Galat J. Use of coronary Palmaz-Schatz stent in the percutaneous treatment of an intracranial carotid artery stenosis. Cathet Cardiovasc Diagn. 1996; 38 316-319
- 73 Mori T, Kazita K, Chokyu K, Mima T, Mori K. Short-term arteriographic and clinical outcome after cerebral angioplasty and stenting for intracranial vertebrobasilar and carotid atherosclerotic occlusive disease. AJNR Am J Neuroradiol. 2000; 21 249-254
- 74 Lylyk P, Cohen J E, Ceratto R, Ferrario A, Miranda C. Angioplasty and stent placement in intracranial atherosclerotic stenoses and dissections. AJNR Am J Neuroradiol. 2002; 23 430-436
Robert F SpetzlerM.D.
c/o Neuroscience Publications, Barrow Neurological Institute
350 W. Thomas Rd., Phoenix, AZ 85013
eMail: neuropub@chw.edu