• Hee Sup Shin, Chang-Woo Ryu, Hak Cheol Ko, Soonchan Park, and Sang-Beom Kim.
• Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
• World Neurosurg. 2017 Dec 1; 108: 303-309.

ObjectiveIsolated chronic middle cerebral artery occlusion (ChMCAO) is not a rare condition and is known to cause hemodynamic stroke. The purpose of this study was to evaluate differences in clinical manifestations and prognosis of isolated ChMCAO in relation to angiographic features.MethodsThis retrospective study enrolled 56 patients with isolated ChMCAO. In accordance with degree of anterograde collateral flow (AF) on angiography, patients were categorized into poor and good AF groups. The 2 groups were assessed and compared for the presence and recurrence of neurologic symptoms.ResultsOf 56 patients, 33 were in the poor AF group and 23 were in the good AF group. The prevalence of ischemic symptoms was significantly higher in the poor AF group compared with the good AF group (P < 0.05). During an average follow-up period of 33.8 months, recurrent ipsilateral symptoms occurred in 6 of 45 patients. The hazard ratio conferred by poor AF was 5.36 (95% confidence interval, 1.08-26.57) for recurrent symptoms.ConclusionsAF through the basal collateral network may be related to clinical manifestations of ChMCAO. Good AF in isolated ChMCAO may play an important role in preventing recurrence of an ischemic event.Copyright © 2017 Elsevier Inc. All rights reserved.

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