From the Guidelines
A middle cerebral artery (MCA) stroke can result in significant morbidity and mortality, with symptoms including contralateral hemiparesis, sensory deficits, aphasia, and spatial neglect, and treatment options including intravenous thrombolysis and mechanical thrombectomy, as demonstrated in the PROACT-II trial 1. The effects of an MCA stroke can be severe and long-lasting, with the potential for significant impact on quality of life.
- Symptoms of an MCA stroke may include:
- Contralateral hemiparesis (weakness) affecting the face and arm more than the leg
- Sensory deficits
- Aphasia if the dominant hemisphere is affected
- Spatial neglect if the non-dominant hemisphere is involved
- Treatment options for MCA stroke include:
- Intravenous thrombolysis with fibrinolytic agents, such as recombinant pro-urokinase (r-proUK), which has been shown to be effective in recanalizing occluded vessels and improving outcomes in patients with MCA occlusion 1
- Mechanical thrombectomy, which can be performed within 24 hours of symptom onset for eligible patients with large vessel occlusion
- The PROACT-II trial 1 demonstrated the efficacy and safety of IA r-proUK for MCA occlusion, with a 15% absolute benefit in the number of patients who achieved an mRSS ≤ 2 at 90 days, and a recanalization rate of 66% after the 2-hour infusion.
- Secondary prevention measures, such as antiplatelet therapy, high-intensity statin therapy, and blood pressure control, are also crucial in reducing the risk of recurrent stroke and improving outcomes.
- Rehabilitation should begin as soon as the patient is medically stable, involving physical, occupational, and speech therapy as needed, to help improve functional outcomes and quality of life.
From the Research
Effects of Middle Cerebral Artery (MCA) Stroke
The effects of a middle cerebral artery (MCA) stroke can be severe and varied. Some of the key effects include:
- Impaired cognitive function and memory
- Weakness or paralysis of the face, arm, or leg
- Difficulty with speech and language
- Vision problems, including blindness or double vision
- Difficulty with swallowing or eating
Clinical Outcomes
Clinical outcomes for patients with MCA strokes can vary depending on several factors, including the location and severity of the stroke, as well as the presence of collateral blood flow 2, 3, 4, 5, 6.
- A study published in 2017 found that patients with MCA M2 segment occlusion who underwent thrombectomy had a good clinical outcome at 3 months in 56% of cases 2.
- Another study published in 2025 found that direct aspiration thrombectomy was associated with a higher first-pass effect rate and better functional outcomes in patients with MCA M2 occlusion 3.
- A study published in 2022 found that rescue stenting technique was effective in patients with acute ischemic stroke due to MCA occlusion after failed thrombectomy, with better recanalization outcomes and good functional outcomes 4.
- The mechanism of stroke can also vary depending on the location and severity of MCA disease, with combined mechanism being most common in proximal MCA disease and artery-to-artery embolism/hemodynamic infarction being most common in distal MCA disease 5.
- Collateral MCA flow can reduce initial stroke severity and is associated with favorable outcomes at 3 months, but may not protect against early neurological deterioration in mild AIS patients with ICA occlusion 6.
Predictors of Outcome
Several factors can predict outcome in patients with MCA strokes, including:
- NIHSS score at admission, with higher scores being associated with poorer outcomes 2, 3
- Age, with older patients being at higher risk of poor outcomes 2
- Time to treatment, with longer times being associated with poorer outcomes 2, 3
- Presence of collateral blood flow, with patients having collateral flow being more likely to have favorable outcomes 6