Clinical Significance of the Champagne Bottle Neck Sign in the Extracranial Carotid Arteries of Patients with Moyamoya Disease

Yasuda, Chiharu; Arakawa, Shuji; Shimogawa, Takafumi; Kanazawa, Yôko; Sayama, Tetsuro; Haga, Sei; Morioka, Takato

doi:10.3174/ajnr.a4815

Cited by 15 publications

(11 citation statements)

References 20 publications

(17 reference statements)

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“…The “bottleneck sign” was significantly associated with ipsilateral intracranial hemorrhage in MMD patients. Our findings coincided with those of Yasuda [ 11 ] and Wang et al [ 12 ]. We discovered that the ID of the ICA and the PSV of the ICA were independent parameters related to ipsilateral cerebral hemisphere stroke in MMD patients.…”

Section: Discussionsupporting

confidence: 93%

“…Yasuda et al [ 11 ] used carotid ultrasound to measure the internal diameter of the ICA and the common carotid artery, and the results showed that with the progression of MMD and the reduction in cerebrovascular reactivity, the ratio of the ICA diameter to the common carotid artery diameter decreased. When the ratio of the two was less than 0.5, it was called the “bottleneck sign”.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound parameters associated with stroke in patients with moyamoya disease: a logistic regression analysis

et al. 2022

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Background Moyamoya disease can lead to stroke with devastating consequences, it is necessary to find a non-invasive and effective approach to identify the occurrence of stroke. In this study, we aim to analyze the association between ultrasound parameters and ipsilateral cerebral hemisphere stroke in patients with moyamoya disease by logistic regression analysis. Methods In this retrospective case–control study, 88 patients with MMD (153 cerebral hemispheres) hospitalized in Beijing Tiantan Hospital, Capital Medical University from November 2020 to October 2021 were analyzed. According to the occurrence of stroke, the 153 cerebral hemispheres were divided into a stroke group and a non-stroke group. Clinical data and ultrasound parameters of the ipsilateral internal carotid artery, superficial temporal artery, maxillary artery, and posterior cerebral artery were recorded. The ultrasound parameters were divided into four groups according to interquartile range, and then they were compared between the stroke group and the non-stroke group. Those with significant differences were scored by multivariate logistic regression analysis. Results There were 75 cerebral hemispheres (49.0%) in the stroke group and 78 cerebral hemispheres (51.0%) in the non-stroke group. Logistic regression analysis showed that the internal diameter of the internal carotid artery, peak systolic velocity of the internal carotid artery and peak systolic velocity of the posterior cerebral artery were independently correlated factors for stroke in patients with MMD. The fourth quartile group of the above three ultrasound parameters was taken as the reference group, and the odds ratio of the first quartile group were 11.679 (95% CI 2.918–46.749, P = 0.001), 19.594 (95% CI 4.973–77.193, P < 0.001), and 11.657 (95% CI 3.221–42.186, P < 0.001), respectively. Conclusion Ultrasound parameters are independently correlated with ipsilateral cerebral stroke in patients with MMD. Ultrasound provides a new way to identify stroke in MMD patients. Future prospective cohort studies are needed to verify the clinical value of ultrasound in identifying patients with MMD at high risk of stroke.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Ultrasound parameters associated with stroke in patients with moyamoya disease: a logistic regression analysis

et al. 2022

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“…Although most researchers have focused on the intracranial portions of the ICA and their branches in MMD, considering the histopathology aspects, MMD causes extracranial stenosis of the proximal portion of the ICA in some cases, the so-called bottleneck sign, which is a typical vascular finding of MMD (27). Yasuda et al (15) reported that the bottleneck sign began to appear in patients with Suzuki stage III or higher. Our results demonstrated that as the Suzuki stage advanced, the D of EICA decreased.…”

Section: Discussionmentioning

confidence: 99%

“…Hong et al (14) demonstrated that flow volume (FV) of the internal carotid artery (ICA) detected by ultrasound was inversely correlated with Suzuki's grade. Yasuda et al (15) showed the ratio of the extracranial ICA (EICA) and common carotid artery diameters tended to be lower in symptomatic arteries than in asymptomatic arteries, the ratio decreased as cerebral vasoreactivity decreased. Wang et al (16) indicated that as the velocity of the PCA decrease, the ischemic lesions spread to a wider range and perfusion levels decreased from good to poor.…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of Ultrasound-Based Hemodynamic Assessment of Extracranial Internal Carotid Artery and Posterior Cerebral Artery in Symptomatic and Angiographic Evolution of Moyamoya Disease: A Preliminary Study

Zheng

Shi

et al. 2021

Front. Neurol.

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Objective: To investigate the hemodynamic changes using ultrasound according to digital subtraction angiography (DSA) findings and explore the association between ultrasound parameters and clinical symptoms of moyamoya disease (MMD).Methods: Hemodynamic parameters of extracranial internal carotid artery (EICA) and posterior cerebral artery (PCA) were evaluated by ultrasound. According to DSA findings, EICA parameters among Suzuki stages (stage I-II, III-IV, and V-VI), and PCA parameters among leptomeningeal system scores (score 0–2, 3–4, and 5–6) were compared, respectively. ROC analysis was performed based on the ultrasound parameters to distinguish stroke from non-stroke patients.Results: Forty patients with MMD were included in our study (16 men; median age, 37 years). The diameter (D), peak systolic velocity (PSV), end diastolic velocity (EDV) and flow volume (FV) of EICA decreased as the Suzuki stage advanced (D: P < 0.001; PSV: P < 0.001; EDV: P < 0.001; FV: P < 0.001). The PSV and EDV of PCA increased as the leptomeningeal system scores advanced (PSV: P < 0.001; EDV: P < 0.001). ROC analysis showed that the area under the curves (AUCs) based on the D and FV of EICA, the PSV and EDV of PCA and their combination were 0.688, 0.670, 0.727, 0.684, and 0.772, respectively, to distinguish stroke from non-stroke patients.Conclusions: Ultrasound parameters were related to Suzuki stages and leptomeningeal system scores. Ultrasound may be useful in predicting the occurrence of stroke in patients with MMD. Future prospective studies with large sample sizes and long-term follow-up are needed to confirm our preliminary findings.

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“…Although most researchers have focused on the intracranial portions of the ICA and their branches in MMD, considering the histopathology aspects, MMD causes extracranial stenosis of the proximal portion of the ICA in some cases, the so-called bottleneck sign, which is a typical vascular nding of MMD [23]. Yasuda et al reported that the bottleneck sign began to appear in patients with Suzuki stage or higher [24]. Our results demonstrated that as the Suzuki stage advanced, the diameter of EICA decreased.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Hemodynamic Parameters Identified by Ultrasound in the Extracranial Internal Carotid Artery and Posterior Cerebral Artery of Patients with Moyamoya Disease

Zheng

Wang

et al. 2020

Preprint

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BackgroundDigital subtraction angiography (DSA), magnetic resonance angiography (MRA) and other imaging methods are limited in the long-term and dynamic examination of hemodynamic changes in moyamoya disease (MMD). The aim of this study was to investigate the hemodynamic changes using ultrasound according to DSA findings and explore the association between ultrasound parameters and clinical manifestations of MMD.MethodsHemodynamic parameters of the extracranial internal carotid artery (EICA) and posterior cerebral artery (PCA) identified by ultrasound were classified into 3 groups according to DSA findings, and differences in ultrasound parameters among DSA stages were compared. Then, according to clinical manifestations, 30 patients were divided into the stroke group and the transient ischemic attack (TIA) group. We compared the differences in the EICA and PCA ultrasound parameters between the two groups, and receiver operating characteristic (ROC) curves were used to evaluate the value of ultrasound parameters in diagnosing stroke and TIA in MMD patients.ResultsThe diameter (D), peak systolic velocity (PSV), end diastolic velocity (EDV) and flow volume (FV) of EICA decreased as the Suzuki stage advanced (D: p༜0 .001, PSV: p = 0.002, EDV: p = 0.001, FV: p༜0.001). The PSV and EDV of PCA increased as the scores of the leptomeningeal system from the PCA to the anterior cerebral artery (ACA) and middle cerebral artery (MCA) territory advanced (PSV: p = 0.002, EDV: p༜0.001). Comparing the ultrasound parameters between the stroke group and the TIA group, the D and FV of EICA, the PSV and EDV of PCA were significantly different. ROC analysis showed that the area under the curve (AUC) based on the FV of EICA, the PSV of PCA and the combination of the two parameters were 0.676, 0.737 and 0.787, respectively, to diagnose stroke and TIA in MMD patients.ConclusionsOur results suggest that ultrasound parameters are related to DSA results, and that ultrasound is useful in predicting the clinical severity of MMD.Trial registration:Clinical Trial Registration-URL: http://www.chictr.org. Unique identifier: ChiCTR1900026075

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Clinical Significance of the Champagne Bottle Neck Sign in the Extracranial Carotid Arteries of Patients with Moyamoya Disease

Cited by 15 publications

References 20 publications

Ultrasound parameters associated with stroke in patients with moyamoya disease: a logistic regression analysis

Ultrasound parameters associated with stroke in patients with moyamoya disease: a logistic regression analysis

Clinical Significance of Ultrasound-Based Hemodynamic Assessment of Extracranial Internal Carotid Artery and Posterior Cerebral Artery in Symptomatic and Angiographic Evolution of Moyamoya Disease: A Preliminary Study

Clinical Significance of Hemodynamic Parameters Identified by Ultrasound in the Extracranial Internal Carotid Artery and Posterior Cerebral Artery of Patients with Moyamoya Disease

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