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Middle cerebral artery stenosis associated with moyamoya pattern collateralization
Randall C Edgell1, Alan S Boulos, Afshin Borhani Haghighi
1Department of Neurology and Psychiatry, Saint Louis University Saint Louis, MO, USA.
Background And Purpose:
Moyamoya disease is a well described phenomenon. This pattern of collateralization associated with isolated middle cerebral artery stenosis and the natural history of this entity have not been well described.
Methods:
Cerebral angiograms and CT angiograms performed between August 2004 and August of 2006 demonstrating moyamoya collateralization were retrospectively reviewed. All cases of middle cerebral artery stenosis associated with a rete pattern of collateralization were included in this series. Demographic, clinical, and angiographic data were obtained.
Results:
There were three cases of middle cerebral artery stenosis associated with a moyamoya pattern of collateralization. The average age of the patients was 36-years old, 2 were male, and all were Caucasian. All patients presented with ischemic symptoms. The average degree of stenosis was 91%. No stenosis was seen in the supraclinoid internal carotid arteries or elsewhere in the intracranial vasculature.
Conclusion:
We describe an unusual pattern of anastomosis associated with isolated severe middle cerebral artery stenosis or occlusion in Caucasians.
Insights
This study describes a rare pattern of collateral blood vessels in patients with severe middle cerebral artery stenosis. This finding is important for understanding moyamoya disease progression and treatment in Caucasian individuals.
Area of Science:
- Neurology
- Vascular Neurology
- Radiology
Background:
- Moyamoya disease is a recognized cerebrovascular condition.
- The specific collateralization pattern linked to isolated middle cerebral artery stenosis is not well-documented.
- The natural history of this specific presentation remains unclear.
Purpose of the Study:
- To describe an unusual collateralization pattern.
- To investigate its association with isolated middle cerebral artery (MCA) stenosis.
- To characterize the demographic, clinical, and angiographic features of affected individuals.
Main Methods:
- Retrospective review of cerebral angiograms and CT angiograms from August 2004 to August 2006.
- Inclusion criteria: moyamoya collateralization with middle cerebral artery stenosis.
- Data collected included demographics, clinical presentation, and angiographic details.
Main Results:
- Three cases of isolated middle cerebral artery stenosis with moyamoya collateralization were identified.
- Patients were Caucasian, with an average age of 36; two were male.
- All presented with ischemic symptoms, and demonstrated an average of 91% MCA stenosis without other intracranial vascular abnormalities.
Conclusions:
- This study highlights an uncommon anastomosis pattern associated with severe, isolated middle cerebral artery stenosis or occlusion.
- The findings are specific to Caucasian patients.
- Further research is warranted to understand the implications of this specific moyamoya pattern.
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