Clinical and Genetic Characteristics of Patients with Moyamoya Disease who Experienced Both Ischemic and Hemorrhagic Events

Hirano, Yuko; Miyawaki, Satoru; Imai, Hideki; Hongo, Hiroki; Teranishi, Yu; Ishigami, Daiichiro; Sakai, Yu; Shimada, Daisuke; Umekawa, Motoyuki; Segawa, Masafumi; Koizumi, Satoshi; Ono, Hideaki; Nakatomi, Hirofumi; Saito, Nobuhito

doi:10.1016/j.wneu.2023.01.047

Cited by 2 publications

(3 citation statements)

References 21 publications

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“…Revascularization procedures are widely accepted in the treatment of MMD patients because they may decrease the rate of ischemic events and improve cerebral blood flow and perfusion ( 10 , 16 , 17 ), effectively reducing the incidence of stroke. Untreated MMD patients have a higher recurrence rate of cerebrovascular events and poorer prognosis when compared to those patients undergoing surgical treatment, regardless of the disease type manifested at the initial attack ( 18–20 ). Independently of the asymptomatic or symptomatic clinical presentation, and the definitive/probable diagnosis, MMD patients demonstrated progression of the disease in up to 20% of cases in the non-surgically treated hemisphere, and ischemic strokes, TIAs or intracranial hemorrhages likely occur in about half of the cases ( 21 ) (29 Japanese guidelines 263 page).…”

Section: Discussionmentioning

confidence: 99%

“…This is primarily due to the unstable condition of intracranial blood vessels on the stenotic side, progressive symptom deterioration, and the compromised brain function and metabolic reserve capacity of these patients. Additionally, some patients may experience the stolen blood syndrome, exacerbating ischemia in the narrow lateral brain tissue and potentially leading to severe stroke events ( 18 ). Therefore, precise preoperative assessment and management, prudent selection of surgical protocols, and early postoperative complication prevention are crucial for patients with uMMD.…”

Section: Discussionmentioning

confidence: 99%

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Vascular architecture characters and risk factors analysis of unstable moyamoya disease

Zhao,

Wu,

Xue

et al. 2024

Front. Neurol.

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BackgroundIn some MMD patients, the digital subtraction angiography (DSA) examination found, occlusion in the ipsilateral internal carotid artery or middle cerebral artery, accompanied by the formation of numerous moyamoya vessels. Conversely, the contralateral internal carotid artery or middle cerebral artery shows signs of stenosis without the presence of moyamoya vessels. Notably, cerebral perfusion studies reveal a similar or even more severe reduction in perfusion on the occluded side compared to the stenotic side. Importantly, clinical symptoms in these patients are typically attributed to ischemia caused by the stenotic side. This condition is referred to as unstable moyamoya disease (uMMD).ObjectiveThis clinical research focuses on evaluating risk factors related to MMD and developing strategies to minimize postoperative complications. The study aims to analyze vascular characteristics and identify potential risk factors in patients with uMMD.MethodsThe authors reviewed consecutive cases with complete clinical and radiological documentation of patients who underwent surgery between January 2018 and June 2023. Univariate analysis and multivariate logistic regression analysis were employed to understand the risk factors and prognosis of postoperative complications in uMMD.ResultsPostoperative complications were retrospectively analyzed in 1481 patients (aged 14 to 65). Among them, 1,429 patients were assigned to the conventional treatment group, while 52 were in the unstable moyamoya disease group. The uMMD treatment group showed a significantly higher incidence of early postoperative complications such as RIND, cerebral infarction, and cerebral hemorrhage (p < 0.05). Univariate and multivariate logistic regression analyses were conducted on the postoperative complications of 52 uMMD patients. Initial symptoms of stenosis ≤50% (univariate: p = 0.008, multivariate: p = 0.015; OR [95% CI] =23.149 [1.853–289.217]) and choosing occluded side surgery (univariate: p = 0.043, multivariate: p = 0.018; OR [95% CI] =0.059 [0.006–0.617]) were identified as significant risk factors for postoperative neurological complications.ConclusionCompared to the conventional treatment group, uMMD has higher complication rates, with vascular stenosis degree and surgical side selection identified as significant risk factors. A comprehensive understanding of preoperative clinical symptoms and vascular characteristics in moyamoya disease patients, coupled with the formulation of rational surgical plans, contributes positively to decreasing postoperative mortality and disability rates in uMMD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Vascular architecture characters and risk factors analysis of unstable moyamoya disease

Zhao,

Wu,

Xue

et al. 2024

Front. Neurol.

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“…The unusual growth of the vascular network and steno occlusive alterations in the circle of Willis are the hallmarks of moyamoya disease, an uncommon cerebrovascular illness [69]. The clinical features of patients with moyamoya disease are usually ischemic or hemorrhagic presentation, while a small number of patients have both ischemic and hemorrhagic symptoms [70]. The most reasonable way to treat this disease is to construct vascular anastomosis channels to increase perfusion to ischemic brain tissue [71,72].…”

Section: Moyamoya Diseasementioning

confidence: 99%

The Greater Omentum: Multifaceted Interactions in Neurological Recovery and Disease Progression

2024

Aging dis

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The greater omentum, a unique anatomical structure composed of adipocytes, loose connective tissue, and a dense vascular network. Plays a pivotal role beyond its traditional understanding. It houses specialized immunological units known as 'Milky spots,' making it a key player in immune response. Moreover, the omentum's capacity to enhance tissue perfusion, absorb edema fluid, boost acetylcholine synthesis, and foster neuron repair have rendered it a topic of interest in the context of various diseases, especially neurological disorders. This review provides a comprehensive overview of the intricate anatomy and histology of the greater omentum, casting light on its multifaceted functions and its associations with a spectrum of diseases. With a specific focus on neurological ailments, we delineate the intricate relationship that the omentum shares with other pathologies like stroke and we underly its contribution to serving as a therapeutic agent in neurological disorders. By deciphering the underlying mechanisms and emphasizing areas that demand further investigation. This review aims to spark renewed interest and pave the way for comprehensive studies exploring the greater omentum's potential in neurology and broader medicine overall. Given these diverse interactions that yet remain elusive, we must investigate and understand the nuanced relationship between the greater omentum and pathologies, especially its role in stroke's pathophysiology and therapeutic interventions so as to enhance patient care.

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Clinical and Genetic Characteristics of Patients with Moyamoya Disease who Experienced Both Ischemic and Hemorrhagic Events

Cited by 2 publications

References 21 publications

Vascular architecture characters and risk factors analysis of unstable moyamoya disease

Vascular architecture characters and risk factors analysis of unstable moyamoya disease

The Greater Omentum: Multifaceted Interactions in Neurological Recovery and Disease Progression

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