Hemodynamic Effects of Middle Cerebral Artery Stenosis and Occlusion

Abstract

Middle cerebral artery (MCA) stenosis and occlusion may cause ischemic symptoms through both hemodynamic and embolic mechanisms. The purpose of this investigation was to determine the hemodynamic effects of these lesions. Ten patients with angiographically confirmed symptomatic occlusion (n ? 5) or stenosis (n = 5) of the Ml segment of the MCA were studied with clinical evaluation, arteriography, and positron emission tomography (PET). Hemodynamic status was categorized by PET as: Stage 0, normal hemodynamics; Stage 1, autoregulatory vasodilatation (increased MTT); and Stage 2, increased OEF. Of five patients with MCA occlusion, three had autoregulatory vasodilatation (Stage 1) and 2 demonstrated increased OEF distal to the lesion (Stage 2).

The MCA territory was supplied solely by pial collaterals in all five patients. Four of the five patients with focal MCA stenosis had normal hemodynamics (Stage 0). One patient was categorized as Stage 1. The frequency of hemodynamic compromise in patients with MCA occlusion is high. Pial collateralization is not a specific sign of increased OEF in patients with MCA occlusion.

Keywords

cerebral blood flow middle cerebral artery occlusion stenosis arteriography PET

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