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Posterior cerebral artery involvement in moyamoya disease: initial infarction and angle between PCA and basilar
Ji Yeoun Lee1, Seung-Ki Kim, Jung-Eun Cheon
1Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
Purpose:
Moyamoya disease (MMD) is a chronic cerebrovascular occlusive disease, and progressive involvement of the posterior cerebral artery (PCA) has been reported. However, majority of MMD articles are presenting classic anterior circulation related issues. This study investigates the preoperative factors related to the long-term outcome of posterior circulation in MMD.
Methods:
Retrospective review of 88 MMD patients (166 PCAs in either hemisphere) without symptomatic disease involvement of PCA at initial diagnosis was done. Data at initial diagnosis regarding age, presence of infarction, status of the PCA, type of posterior communicating artery, and the angle between PCA and basilar artery were reviewed. Progressive stenosis of PCA was evaluated by symptom or radiological imaging during follow up.
Results:
During an average follow up of 8.3 years, 29 out of 166 (18 %) evaluated PCAs showed progressive disease involvement. The average time of progression from the initial operation was 4.9 years, with the latest onset at 10.8 years. The patients who showed progressive stenosis of the PCA tended to be younger, present with infarction, have smaller angle between PCA and basilar artery, and have asymptomatic stenosis of the PCA at initial presentation. However, multivariate analysis confirmed only the presence of initial infarction and a smaller angle between PCA and basilar artery to be significantly associated with progressive stenosis of PCA.
Conclusions:
Involvement of PCA in MMD may occur in a delayed fashion, years after the completion of revascularization of anterior circulation. Persistent long-term follow-up regarding the posterior circulation is recommended.
Insights
Moyamoya disease (MMD) posterior circulation can worsen years after treatment. Initial infarction and a smaller posterior cerebral artery (PCA) angle predict progressive PCA stenosis in MMD patients.
Area of Science:
- Neurology
- Cerebrovascular Diseases
- Neuroscience
Background:
- Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of intracranial arteries.
- While anterior circulation involvement is well-documented, posterior circulation progression in MMD requires further investigation.
Purpose of the Study:
- To identify preoperative factors associated with long-term outcomes of posterior circulation in Moyamoya disease.
- To investigate predictors of progressive posterior cerebral artery (PCA) stenosis in MMD patients.
Main Methods:
- Retrospective review of 88 MMD patients with 166 evaluated PCAs.
- Analysis of preoperative data including age, infarction, PCA status, and basilar artery angle.
- Long-term follow-up (average 8.3 years) assessing symptomatic or radiological PCA progression.
Main Results:
- 18% of evaluated PCAs showed progressive stenosis over an average of 8.3 years.
- Younger age, initial infarction, and smaller PCA-basilar artery angle were associated with progression.
- Multivariate analysis identified initial infarction and smaller PCA-basilar artery angle as significant predictors.
Conclusions:
- Posterior circulation involvement in MMD can manifest years after anterior circulation revascularization.
- Persistent long-term follow-up is crucial for monitoring posterior circulation in MMD patients.
- Identifying at-risk patients with initial infarction or specific anatomical features aids in proactive management.
