Ischemic patterns and their angiographic risk factors in adult patients with moyamoya disease
Si Luo1, Wenjie Zhan1, Lanjiao Zhang1
1Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China.
Objective:
The present study aims to determine whether angiographic differences increase the risk of ischemic pattern among adult patients with moyamoya disease (MMD).
Methods:
From January 2020 to December 2021, we retrospectively enrolled 123 ischemic or asymptomatic adult patients diagnosed as MMD. Angiographic changes including Suzuki stage, moyamoya vessels, anterior choroidal artery (AChoA) dilatation, lenticulostriate artery (LSA) dilatation, posterior communicating artery (PcomA) dilatation, and posterior cerebral artery (PCA) involvement were evaluated for all patients.
Results:
Among the 123 participants, 35 ischemic patients and 88 asymptomatic patients were analyzed. There was no significant difference of Suzuki stage, AChoA dilatation, LSA dilatation, and PcomA dilatation between ischemic group and asymptomatic group. The grading of moyamoya vessels differed significantly but was not a factor associated with ischemic pattern after adjusting multiple related confounders. However, the frequency of PCA steno-occlusive changes in ischemic patients was statistically higher than that in asymptomatic patients (54.3% vs 34.1%, p = 0.039). Furthermore, PCA involvement was a risk factor associated with ischemic form and remained statistically significant after the multivariate adjustment (p = 0.033, 95% CI 1.092-8.310).
Interpretation:
PCA involvement is closely related to the presentation of ischemic stroke but other angiographic features had no association with ischemic pattern in adult MMD.
Insights
Posterior cerebral artery involvement is a key risk factor for ischemic stroke in adult moyamoya disease (MMD). Other angiographic features showed no significant association with ischemic patterns in MMD patients.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of the internal carotid arteries and the development of collateral vessels.
- Ischemic stroke is a major complication of MMD, and identifying risk factors is crucial for patient management.
Purpose of the Study:
- To investigate the association between various angiographic features and the risk of ischemic stroke in adult patients with MMD.
- To determine if specific angiographic differences predict ischemic events in MMD.
Main Methods:
- Retrospective analysis of 123 adult MMD patients (ischemic and asymptomatic) diagnosed between January 2020 and December 2021.
- Evaluation of angiographic findings including Suzuki stage, moyamoya vessels, and dilatations of anterior choroidal artery (AChoA), lenticulostriate artery (LSA), and posterior communicating artery (PcomA).
- Assessment of posterior cerebral artery (PCA) steno-occlusive changes and their correlation with ischemic patterns, with multivariate adjustment for confounders.
Main Results:
- Posterior cerebral artery (PCA) steno-occlusive changes were significantly more frequent in ischemic MMD patients (54.3%) compared to asymptomatic patients (34.1%) (p=0.039).
- PCA involvement was identified as an independent risk factor for ischemic stroke in MMD, remaining significant after multivariate analysis (p=0.033).
- No significant differences were observed in Suzuki stage, AChoA, LSA, or PcomA dilatation between ischemic and asymptomatic groups.
Conclusions:
- Posterior cerebral artery (PCA) involvement is strongly associated with the occurrence of ischemic stroke in adult moyamoya disease (MMD).
- While moyamoya vessel grading showed differences, it was not an independent risk factor for ischemic events after adjusting for confounders.
- Other evaluated angiographic features, including Suzuki stage and dilatations of AChoA, LSA, and PcomA, did not correlate with the ischemic pattern in adult MMD.
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