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(Stroke. 2007;38:1418.)
© 2007 American Heart Association, Inc.

Controversies in Stroke

Middle Cerebral Artery Stenosis: Stenting Is One of the Options

Yes

From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.

Correspondence to Ming Liu, MD, Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China. E-mail wyplmh@hotmail.com

Geoffrey A. Donnan MD, FRACP Stephen M. Davis MD, FRACP Section Editors

Key Words: MCA • stenting

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Intracranial artery stenosis is an important cause of ischemic stroke among Asians, Hispanics, and blacks, especially in Chinese populations ^1–2 and accounts for 8% to 10% of all ischemic strokes.^3–4 The annual risk of recurrent stroke in patients with intracranial artery stenosis varies from 10% to 50%.^5–6 Despite medical therapy, symptomatic intracranial stenosis carried a 10% to 24% annual risk of stroke.⁷ Patients with severe middle cerebral artery (MCA) stenosis had the worse outcome. The traditional medical treatments are antiplatelet or anticoagulation therapy and risk factor control. Anticoagulation had been regarded as superior to antiplatelet therapy for patients with symptomatic intracranial artery stenosis. However, the recent prospective Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial was prematurely terminated owing to safety concerns associated with significantly higher rates of adverse events in the warfarin group, and warfarin provided no benefit over aspirin for preventing stroke and vascular death. Ischemic stroke, brain hemorrhage, or death from vascular causes other than stroke occurred within 2 years in 22% of the patients, whether they were treated with high-dose aspirin (1300 mg per day) or warfarin.⁸ This showed that symptomatic intracranial atherosclerotic stenosis is a marker of aggressive vascular disease, for which the current medical treatment is far from satisfactory. Therefore, alternative therapies, such as aggressive management of risk factors, alternative antiplatelet regimens, and intracranial angioplasty with or without stenting might be desired.

The earliest reports of balloon angioplasty for intracranial atherosclerotic stenosis were reported in 1980s. Recently, percutaneous transluminal angioplasty has been proposed as a promising treatment . . . [Full Text of this Article]