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Morphologic differences between ruptured and unruptured choroidal anastomosis in adult moyamoya disease: a
Jiwook Ryu1, Kyung Mi Lee2, Ho Geol Woo3
1Departments of1Neurosurgery.
Insights
Choroidal anastomosis (ChA) rupture risk in moyamoya disease is higher with larger lumen area and periventricular anastomosis score 1. These findings aid in preventing future hemorrhages.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Choroidal anastomosis (ChA) is a key indicator of hemorrhagic risk in adult moyamoya disease.
- Identifying risk factors for ChA rupture is crucial for patient management.
Purpose of the Study:
- To identify potential risk factors influencing the rupture of choroidal anastomosis (ChA) in adult moyamoya disease.
- To determine predictors of ruptured ChA for improved hemorrhage prevention strategies.
Main Methods:
- Retrospective analysis of clinical and radiological data from moyamoya disease patients with ChA.
- Quantitative assessment of ChA lumen diameter (LD) and lumen area (LA) using high-resolution vessel wall imaging (VWI).
- Multivariate logistic regression to identify independent risk factors for ruptured ChA.
Main Results:
- Ruptured ChAs exhibited significantly larger mean LD and LA compared to unruptured ChAs.
- A periventricular anastomosis (PA) score of 1 was more prevalent in ruptured ChA hemispheres.
- Larger LA (> 1.285 mm2) and PA score 1 were independently associated with ruptured ChA.
Conclusions:
- Increased ChA lumen area and the presence of periventricular anastomosis alone are independent risk factors for ChA rupture.
- These findings can guide treatment decisions, including revascularization surgery, for high-risk unruptured ChA.
- Identifying these risk factors aids in tailoring treatment strategies to prevent future hemorrhages in moyamoya patients.
Objective:
Choroidal anastomosis (ChA) has been implicated as the main indicator of an increased hemorrhagic risk in adult moyamoya disease. In this retrospective study, the authors aimed to identify the potential risk factors that can influence the rupture of ChA.
Methods:
The authors evaluated the clinical and radiological data on brain hemispheres positive for ChA from September 2019 to March 2023. The rupture status of the ChA was determined using previously described methods. Two independent raters quantitatively investigated the lumen diameter (LD) and lumen area (LA) of the ChA using high-resolution vessel wall imaging (VWI). Multivariate logistic regression analysis was conducted to identify the risk factors for ruptured ChA.
Results:
Ruptured and unruptured ChAs were identified in 16 and 60 hemispheres, respectively. Univariate analysis showed that the mean values of the LD (1.251 ± 0.241 vs 0.967 ± 0.214 mm, p < 0.001) and LA (1.607 ± 0.445 vs 0.945 ± 0.372 mm2, p < 0.001) of ChAs were significantly greater in the ruptured group than in the unruptured group. A periventricular anastomosis (PA) score of 1, indicating the angiographic presence of ChA alone, was more prevalent in the ruptured group than in the unruptured group (43.8% vs 11.7%, p = 0.003). Multivariate analysis demonstrated that a larger LA of the ChA (OR 37.01, 95% CI 5.787-236.7, p < 0.001) and PA score 1 (OR 6.661, 95% CI 1.260-35.21, p = 0.026) were independently associated with ruptured ChA hemispheres. Receiver operating characteristic curve analysis revealed that the optimal cutoff point for the LA was 1.285 mm2 (sensitivity 81.3%, specificity 86.7%).
Conclusions:
A larger LA (> 1.285 mm2) of the ChA and the angiographic presence of ChA alone are independent risk factors for a ruptured ChA. Revascularization surgery for the prevention of future hemorrhage may be indicated for hemispheres with a high-risk unruptured ChA. These characteristics may help to determine treatment strategies for patients with an unruptured ChA.
