Objective      To evaluate and compare the safety and long-term therapeutic efficacy of stenting versus drug therapy in the treatment of symptomatic middle cerebral artery stenosis.       Methods      A retrospective study of 146 patients with symptomatic middle cerebral artery atherosclerosis stenosis (stenosis 70%) enrolled in the second affiliated hospital of Zhengzhou university from October 2009 to January 2015 was performed. The patients were divided to stenting group (n=67) and drug group (n=79). The data

including patients’ clinical baseline information

imaging of pre- and post-operation

perioperative complications

adverse events during clinical follow-up and outcomes of imaging follow-up

were recorded prospectively and analyzed retrospectively.       Results      (1) After 30 d of treatment

4 patients (6.0%

4/67) had stroke including 2 cases (3.0%

2/67) of fatal or disabling stroke in the stenting group

whereas 3 patients (3.8%

3/79) occurred ischemic stroke including 1 case (1.3%

1/79) of disabling stroke in the drug group. The risk of stroke including fatal or disabling stroke in the stenting group was slightly higher than that in the drug group

but the difference was not significant (P0.05). (2) The mean follow-up period for all patients was 20.8±9.2 months. After a follow-up of 30 d

4 ipsilateral strokes (6.2%

4/65) occurred in the stenting group

none of which were fatal or disabling strokes; 7 ipsilateral strokes (9.0%

7/78) were found in the drug group

which 6 patients (7.7%

6/78) had disabling strokes. Although the incidence of stroke between the 2 groups was not significant (P0.05)

the occurrence rate of disabling stroke in the stenting group was much lower than that in the drug group (P=0.032).       Conclusion      The safety of stenting is slightly worse than that of drug therapy in the treatment of symptomatic middle cerebral artery stenosis. The overall effect of the 2 therapeutic regimens on stroke prevention is not significantly different. However

stenting treatment is superior to drug therapy in a long-term prevention of recurrent fatal or disabling stroke.