Angiographic Analysis of Natural Anastomoses between the Posterior and Anterior Cerebral Arteries in Moyamoya Disease and Syndrome

Abstract

BACKGROUND AND PURPOSE: Moyamoya disease is a chronic neurovascular steno-occlusive disease of the internal carotid artery and its main branches, associated with the development of compensatory vascular collaterals. Literature is lacking about the precise description of these compensatory vascular systems. Usually, the posterior circulation is less affected, and its vascular flow could compensate the hypoperfusion of the ICA territories. The aim of this study was to describe these natural connections between the posterior cerebral artery and the anterior cerebral artery necessary to compensate the lack of perfusion of the anterior cerebral artery territories in the Moyamoya population. MATERIALS AND METHODS: All patients treated for Moyamoya disease from 2004 to 2018 in 4 neurosurgical centers with available cerebral digital subtraction angiography were included. Forty patients (80 hemispheres) with the diagnosis of Moyamoya disease were evaluated. The presence of anastomoses between the posterior cerebral artery and the anterior cerebral artery was found in 31 hemispheres (38.7%). RESULTS: Among these 31 hemispheres presenting with posterior cerebral artery-anterior cerebral artery anastomoses, the most frequently encountered collaterals were branches from the posterior callosal artery (20%) and the posterior choroidal arteries (20%). Another possible connection found was pio-pial anastomosis between cortical branches of the posterior cerebral artery and the anterior cerebral artery (15%). We also proposed a 4-grade classification based on the competence of these anastomoses to supply retrogradely the territories of the anterior cerebral artery. CONCLUSIONS: We found 3 different types of anastomoses between the anterior and posterior circulations, with different abilities to compensate the anterior circulation. Their development depends on the perfusion needs of the territories of the anterior cerebral artery and can provide the retrograde refilling of the anterior cerebral artery branches. ABBREVIATIONS: ACA 4 anterior cerebral artery; PCA 4 posterior cerebral artery M oyamoya disease is a neurovascular pathology characterized by the progressive stenosis of the supraclinoidal portion of the ICA and its 2 main branches: the anterior cerebral artery (ACA) and MCA in their proximal segments. 1-3 During the evolution of the pathology, the development of natural collaterals allows maintaining a minimal perfusion to the cerebral parenchyma and, in particular, the ACA territories. 2,4,5 The knowledge of the collateral circles and the specific connections that the patient develops during the natural history of this disease is still not well-known, and just a few studies in the literature are dedicated to their analysis. 6-9 In a recent study, 8 we described the role of collaterals from the ophthalmic artery in supplying the ACA territory. However, the other collateral circles are still not known in detail. Due to this important absence in the literature, we proposed to analyze the other collateral circles in Moyamoya d...

The Significance to Determine Factors Related to Postoperative Cerebral Infarction in Patients with Moyamoya Disease

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The significance of leptomeningeal collaterals in moyamoya disease

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Progression in Moyamoya Disease: Clinical Features, Neuroimaging Evaluation, and Treatment

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