Journal of Thrombosis and Thrombolysis

, Volume 25, Issue 3, pp 265–269 | Cite as

Factors related to progression of middle cerebral artery stenosis determined using transcranial Doppler ultrasonograhy

Article

Abstract

Atherosclerosis plays an important role in ischemic stroke. We conducted this prospective study to determine significant factors related to progression of middle cerebral artery (MCA) stenosis. We studied 103 patients with MCA stenosis using transcranial Doppler (TCD) and re-evaluated the TCD results at 6 months after the initial investigation and measured platelet aggregability for adenosine diphosphate (ADP) or arachidonic acid (AA). After 6 months, 13 (12.6%) patients showed worsening, whereas 90 were stationary or showed regression upon TCD examination. In a univariate analysis, the history of ischemic stroke (P = 0.023), the presence of significant carotid stenosis (P = 0.027), the prescription of aspirin only (P = 0.046), the grade of stenosis in the MRA (P = 0.0048), and the platelet aggregability for ADP (P = 0.015) were significantly associated with the progression of MCA stenosis. After multiple logistic regression analysis, the grades of stenosis and platelet aggregability for ADP were independent factors related to the progression of MCA stenosis. In this study, the grade of MCA stenosis on angiography might be an important factor to predict the progression upon serial TCD examination. Also, the extent of inhibition of platelet activation could be a possible role to determine on the progression of MCA stenosis.

Keywords

Intracranial stenosis Aspirin Atherosclerosis 

References

  1. 1.
    Fisher CM, Gore I, Okabe N, White PD (1965) Atherosclerosis of the carotid and vertebral arteries: extracranial and intracranial. J Neuropathol Exp Neurol 24:455–476CrossRefGoogle Scholar
  2. 2.
    Huang YN, Gao S, Li SW, Lam WW, Chan YL, Kay R (1997) Vascular lesions in Chinese patients with transient ischemic attacks. Neurology 48:524–525PubMedGoogle Scholar
  3. 3.
    Wong KS, Li H, Lam WW, Chan YL, Kay R (2002) Progression of middle cerebral artery occlusive disease and its relationship with further vascular events after stroke. Stroke 33:532–536PubMedCrossRefGoogle Scholar
  4. 4.
    Rother J, Schwartz A, Rautenberg W, Hennerici M (1994) Middle cerebral artery stenoses: assessment by magnetic resonance angiography and transcranial Doppler ultrasound. Cerebrovasc Dis 4:273–279CrossRefGoogle Scholar
  5. 5.
    Tsai NW, Chang HW, Chang WN et al (2005) Prognostic factors and therapeutic outcome of isolated symptomatic middle cerebral artery stenosis. Eur J Neurol 12:519–526PubMedCrossRefGoogle Scholar
  6. 6.
    Ross R (1999) Mechanisms of disease: atherosclerosis is an inflammatory disease. N Engl J Med 340:115–126PubMedCrossRefGoogle Scholar
  7. 7.
    Campo G, Valgimigli M, Gemmati D et al (2006) Value of platelet reactivity in predicting response to treatment and clinical outcome in patients undergoing primary coronary intervention: insights into the STRATEGY study. J Am Coll Cardiol 48:2178–2185PubMedCrossRefGoogle Scholar
  8. 8.
    Markus HS, Droste DW, Kaps M, Larrue V, Lees KR, Siebler M, Ringelstein EB (2005) Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation 111:2233–2240PubMedCrossRefGoogle Scholar
  9. 9.
    Kasner SE, Chimowitz MI, Lynn MJ et al (2006) Warfarin aspirin symptomatic intracranial disease trial investigators. Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation 113(4):555–563. Epub 2006 Jan 23PubMedCrossRefGoogle Scholar
  10. 10.
    Kwon SU, Cho YJ, Koo JS, Bae HJ, Lee YS, Hong KS, Lee JH, Kim JS (2005) Cilostazol prevents the progression of the symptomatic intracranial arterial stenosis: the multicenter double-blind placebo-controlled trial of cilostazol in symptomatic intracranial arterial stenosis. Stroke 36:782–786PubMedCrossRefGoogle Scholar
  11. 11.
    Demchuk AM, Christou L, Wein TH, Felberg RA, Malkoff M, Grotta JC, Alexandrov AV (2000) Specific transcranial Doppler flow findings related to the presence and site of arterial occlusion. Stroke 31:140–146PubMedGoogle Scholar
  12. 12.
    Alexandrov AV, Demchuk AM, Wein TH, Grotta JC (1999) Yield of transcranial Doppler in acute cerebral ischemia. Stroke 30:1604–1609PubMedGoogle Scholar
  13. 13.
    Burgin WS, Malkoff M, Demchuk AM, Felberg RA, Christou I, Grotta JC, Alexandrov AV (2000) Transcranial Doppler ultrasound criteria for recanalization after thrombolysis for middle cerebral artery stroke. Stroke 31:1128–1132PubMedGoogle Scholar
  14. 14.
    Kern R, Steinke W, Daffertshofer M, Prager R, Hennerici M (2005) Stroke recurrences in patients with symptomatic vs asymptomatic middle cerebral artery disease. Neurology 65:859–864PubMedCrossRefGoogle Scholar
  15. 15.
    The EC/IC Bypass Study Group (1985) Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke: results of an international randomized trial. N Engl J Med 313:1191–1200CrossRefGoogle Scholar
  16. 16.
    Kimura K, Minematsu K, Koga M, Arakawa R, Yasaka M, Yamagami H, Nagatsuka K, Naritomi H, Yamaguchi T (2001) Microembolic signals and diffusion-weighted MR imaging abnormalities in acute ischemic stroke. Am J Neuroradiol 22:1037–1042PubMedGoogle Scholar
  17. 17.
    Lammie GA, Sandercock PAG, Dennis MS (1999) Recently occluded intracranial and extracranial carotid arteries: relevance of the unstable atherosclerotic plaque. Stroke 30:1319–1325PubMedGoogle Scholar
  18. 18.
    Inzitari D, Hachinski V, Taylor DW, Barnett HJM (1990) Racial differences in the anterior circulation in cerebrovascular disease: how much can be explained by risk factors? Arch Neurol 47:1080–1084PubMedGoogle Scholar
  19. 19.
    Mull M, Schwartz M, Thron A (1997) Cerebral hemispheric low-flow infarcts in arterial occlusive disease: lesion patterns and angiomorphological conditions. Stroke 28:118–123PubMedGoogle Scholar
  20. 20.
    Makkar RR, Eigler NL, Kaul S et al (1998) Effects of clopidogrel, aspirin and combined therapy in a porcine ex vivo model of high-shear induced stent thrombosis. Eur Heart J 19:1538–1546PubMedCrossRefGoogle Scholar
  21. 21.
    Cha JK, Jeong MH, Lee KM, Bae HR, Lim YJ, Park KW, Cheon SM (2002) Changes in platelet P-selectin and in plasma C-reactive protein in acute atherosclerotic ischemic stroke treated with a loading dose of clopidogrel. J Thromb Thrombolysis 14:145–150PubMedCrossRefGoogle Scholar
  22. 22.
    Markus HS, Droste DW, Kaps M, Larrue V, Lees KR, Siebler M, Ringelstein EB (2005) Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using Doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation 111:2233–2240PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Department of Neurology, College of MedicineDong-A University HospitalBusanKorea

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