Angiographic and Hemodynamic Features in Asymptomatic Hemispheres of Patients With Moyamoya Disease
Haogeng Sun1, Wanjiang Li2, Chao Xia1,3
1Department of Neurosurgery (H.S., C.X., Y.R., L.M., A.X., C.Y., Y.L., R.T.), West China Hospital, Sichuan University, Chengdu, China.
Background And Purpose:
There is also a risk of stroke in the asymptomatic hemispheres of moyamoya disease (MMD), but it does not draw enough attention. The study investigated the differences between the three types of asymptomatic hemispheres in MMD and their associations with the two types of symptomatic hemispheres, respectively.
Methods:
Retrospectively reviewed clinical and imaging characteristics of asymptomatic and symptomatic hemispheres in consecutive cases of single-center MMD patients, with an emphasis on imaging characterization regarding vascular morphology and cerebral perfusion. MMD hemispheres were categorized into 5 types: hemorrhagic hemispheres, ischemic hemispheres, asymptomatic hemispheres in unilateral hemorrhagic MMD, asymptomatic hemispheres in unilateral ischemic MMD, and bilateral asymptomatic hemispheres in MMD. Angiographic feature was assessed by Suzuki's angiographic stage, while hemodynamic feature was assessed by preinfarction period stage.
Results:
One hundred ninety-four MMD patients with 388 hemispheres were enrolled. Asymptomatic hemispheres in unilateral hemorrhagic MMD were largely similar to hemorrhagic hemispheres, both had more advanced Suzuki's angiographic stage and lower degree of hemodynamic failure compared with bilateral asymptomatic hemispheres in MMD and asymptomatic hemispheres in unilateral ischemic MMD. Asymptomatic hemispheres in unilateral ischemic MMD were similar to ischemic hemispheres, both had less advanced Suzuki's angiographic stage and higher degree of hemodynamic failure compared with bilateral asymptomatic hemispheres in MMD and asymptomatic hemispheres in unilateral hemorrhagic MMD. Bilateral asymptomatic hemispheres in MMD were different from the other hemispheres and had less advanced Suzuki's angiographic stage and lower degree of hemodynamic failure.
Conclusions:
The three types of asymptomatic hemispheres in MMD are defined and have unique angiographic and hemodynamic features. Different combinations of the two features can reflect the tendency of pathological evolution in these different asymptomatic hemispheres.
Insights
Moyamoya disease (MMD) asymptomatic hemispheres have distinct imaging and hemodynamic features. Understanding these differences is crucial for predicting pathological evolution and stroke risk in MMD patients.
Area of Science:
- Neurology
- Radiology
- Vascular Neurology
Background:
- Moyamoya disease (MMD) poses a stroke risk even in asymptomatic brain regions.
- The characteristics of these asymptomatic hemispheres are often overlooked.
- This study focuses on differentiating MMD hemisphere types and their clinical implications.
Purpose of the Study:
- To investigate the distinct features of three types of asymptomatic hemispheres in MMD.
- To explore the association between asymptomatic and symptomatic hemispheres in MMD.
- To enhance understanding of stroke risk in MMD patients.
Main Methods:
- Retrospective analysis of clinical and imaging data from 194 MMD patients.
- Categorization of MMD hemispheres into five types based on clinical presentation and imaging.
- Assessment of angiographic features using Suzuki's stage and hemodynamic status via preinfarction period stage.
Main Results:
- Asymptomatic hemispheres in unilateral hemorrhagic MMD resemble hemorrhagic hemispheres, showing advanced Suzuki stage and less hemodynamic compromise.
- Asymptomatic hemispheres in unilateral ischemic MMD are similar to ischemic hemispheres, with less advanced Suzuki stage and greater hemodynamic compromise.
- Bilateral asymptomatic hemispheres in MMD exhibit unique features, with less advanced Suzuki stage and lower hemodynamic compromise compared to other types.
Conclusions:
- Three types of asymptomatic MMD hemispheres possess unique angiographic and hemodynamic profiles.
- The combination of these features can indicate the potential pathological progression.
- This classification aids in understanding stroke risk and disease evolution in MMD.
