Novel Approaches in Evaluating and Predicting the Potential Benefit of Middle Cerebral Artery Angioplasty & Stenting

Abstract

Objective: Our aim was to investigate a novel approach to perform preoperative evaluation patients who underwent middle cerebral artery (MCA) percutaneous transluminal angioplasty and stenting (PTAS).

Method: Sixty-five patients with symptomatic MCA stenosis of at least >70% who underwent MCA PTAS were enrolled. The multimodal stroke assessment using CT (MOSAIC) score was used to evaluate the preoperative condition. The Alberta Stroke Program Early Computed Tomography Scoring (ASPECTS) was used to assess the time-to-peak (TTP) parameter of Computer tomography perfusion (CTP). The factors potentially improving TTP following stenting were investigated. The prognostic value of the MOSAIC scores to predict TTP improvement was analyzed and compared.

Results: The MOSAIC score was a reliable prognostic tool for the degree of improvement of TTP (odds ratio 1.89 [1.08-2.07], P < .01) in patients with PTAS. The MOSAIC score had a higher prognostic accuracy than the degree of CBF deficit, the degree of stenosis, and the amount of tissue infarction. During 1-year follow-up, the stroke and death rate of was 8.1%, the in-stent restenosis rate was 6.5%, and good final outcome (modified Rankin Scale ≤ 2) was observed in 76.9%.

Conclusions: The MOSAIC score can be reliably used in selecting patients with MCA stenosis for PTAS.

Keywords: ASPECTS; MCA stenosis; MOSAIC scores; PTAS.