Background: Atherosclerotic stenosis of the middle cerebral artery (MCA) is uncommon and long-term prognosis is not well defined. Methods of treating stenosis of the MCA range from the administration of anticoagulants to endarterectomy.
Methods: We present two cases of patients with focal symptomatic stenosis of the MCA with evidence of focally decreased cerebral blood flow and compromise of cerebral blood flow reserves on xenon-enhanced computed tomography (Xe CT) scanning. Endarterectomies were performed after unsuccessful anticoagulation therapy.
Results: Both patients underwent successful endarterectomies of the MCA. Improvement in cerebral blood flow postoperatively was documented for both patients. At last follow-up neither patient had demonstrated any additional ischemic episodes.
Conclusions: Atherosclerotic stenosis of the MCA may be responsible for distal emboli and compromised hemodynamics, and endarterectomy of this vessel may provide definitive therapy.