Clinical Significance of Posterior Circulation Changes after Revascularization in Patients with Moyamoya Disease

Huang, Abel Po‐Hao; Liu, Hon‐Man; Lai, Dar Ming; Yang, Chi; Tsai, Yi Hsin; Wang, Kuo-Chuan; Yang, Shyh‐Chyun; Kuo, Meng-Fai; Tu, Yong Kwang

doi:10.1159/000228254

Cited by 50 publications

(39 citation statements)

References 37 publications

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“…We also found that PCA involvement was a risk factor for postoperative ischemic complications and subsequent strokes, which was similar to prior studies [39,40,41]. In MMD, the leptomeningeal collaterals from the uninvolved PCA generally compensate somewhat for the cerebral blood flow in the ACA or MCA territory [39,42]. However, when steno-occlusive lesions also involve the PCA and decrease the leptomeningeal collaterals to the ACA or MCA territory, postoperative ischemic complications or subsequent infarctions result in that territory [41,42].…”

Section: Discussionsupporting

confidence: 92%

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Clinical Features, Surgical Treatment and Long-Term Outcome in Adult Patients with Moyamoya Disease in China

Bao

Duan

et al. 2012

Cerebrovasc Dis

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Background: Moyamoya disease (MMD) develops mostly in Asian countries including Japan, Korea, mainland China and Taiwan. However, there are few detailed demographic and clinical data about Chinese patients with MMD. Currently, the most effective treatment in adult patients with MMD is unknown. There have only been a few small case series reporting on encephaloduroarteriosynangiosis (EDAS) in an adult population. Here we describe the clinical features, surgical treatment and long-term outcome of adults with MMD treated at a single institution in China. Methods: Our cohort included 470 adult patients with MMD. The demographic and clinical characteristics were obtained by retrospective chart review and long-term outcome was evaluated using the stroke status. The modified Rankin Scale (mRS) was used to determine the neurological functional outcome. Univariate and multivariate logistic regression analyses were performed to determine risk factors for postoperative morbidity and functional outcome. The risk of subsequent stroke was determined using the Kaplan-Meier method and Cox regression was used to determine risk factors for postoperative or subsequent strokes. Results: The median age for the onset of symptoms was 36.8 (range, 18–59) years. The ratio of female to male patients was 1:1 (231/239). Familial occurrence of MMD was 2.3%. The most common initial symptom was a cerebral ischemic event. The incidence of postoperative ischemic events or hemorrhage was 5.9% (9.8% of patients). Older age at symptom onset, posterior cerebral artery (PCA) involvement and the presence of transient ischemic attack (TIA) were identified as predictors of adverse postoperative events. The Kaplan-Meier estimate stroke risk was 10.1% in the first 2 years, and the 5-year Kaplan-Meier risk of stroke was 13% after surgery for all patients treated with surgical revascularization. Older age at symptom onset, PCA involvement and the presence of TIA were identified as predictors of postoperative or subsequent strokes. Overall, 73.2% of patients had an independent life with no significant disability, with the strongest predictor being the preoperative mRS score. Conclusion: Clinical characteristics of adult MMD in China are different from those in other Asian countries. EDAS in adult patients with MMD carries a low risk, is effective at preventing future ischemic events and improves quality of life.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Clinical Features, Surgical Treatment and Long-Term Outcome in Adult Patients with Moyamoya Disease in China

Bao

Duan

et al. 2012

Cerebrovasc Dis

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“…5,6,11,14,32,34 Preoperative cerebral infarction, younger age at onset, involvement of the PCA, intentional hypotension, high Suzuki stage, and postoperative ischemic events have been observed to correlate with postoperative complications and outcomes. According to the multivariate logistic regression analyses, our study showed that PCA involvement in both groups with no statistically significant differences preoperatively together with the late postoperative stroke was associated with unfavorable clinical outcomes, which was similar to the previous results observed in our center.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Surgical outcomes following encephaloduroarteriosynangiosis in adult moyamoya disease associated with Type 2 diabetes

Ren

Zhang

Liu

et al. 2016

JNS

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M oyaMoya disease (MMD), a cerebral vascular disease, is characterized by progressive stenosis and occlusion of the terminal portion of the bilateral internal carotid arteries, leading to the formation of an abnormal vascular network composed of collateral pathways at the base of the brain. MMD can cause a reduction in the blood supply to the brain, and there are 2 major etiological categories of symptoms: those due to brain ischemia (i.e., stroke, transient ischemic attack, and seizure) and those due to the deleterious consequences of the compensatory mechanisms in response to ischemia (i.e., hemorrhage from fragile collateral vessels and headache aBBreViatiONS CBF = cerebral blood flow; DM = diabetes mellitus; EDAS = encephaloduroarteriosynangiosis; MCA = middle cerebral artery; MMD = moyamoya disease; mRS = modified Rankin Scale; PCA = posterior cerebral artery; STA = superficial temporal artery; T2DM = Type 2 DM. SuBmitted January 29, 2015. OBJectiVe Debate exists regarding the merits and shortcomings of an indirect bypass procedure for treating adult patients with moyamoya disease (MMD). Considerable variation in neovascularization occurs among different organs in patients with diabetes mellitus. Here, the effect of encephaloduroarteriosynangiosis on MMD associated with Type 2 diabetes mellitus (T2DM) is evaluated. methOdS A retrospective and 1:2 matched case-control study was conducted in moyamoya patients with or without T2DM (n = 180). Postoperative collateral formations were graded according to the Modified Collateral Grading System that originated from the Matsushima Angiographic Stage Classification. Neurological function outcomes before and after the operation were evaluated according to the modified Rankin Scale. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for clinical outcome. reSultS There was no statistically significant difference in the constituent ratios of initial symptom and preoperative Suzuki stage between patients with and without T2DM. Progression of angiopathy around the circle of Willis was postoperatively observed in bilateral internal carotid arteries in both groups. Patients with T2DM had a higher postoperative Suzuki stage (p < 0.01) and more frequent development of collateral angiogenesis germinating from the external carotid after indirect revascularization procedures in the surgical cerebral hemisphere (82.7% vs 72.2%; p < 0.05). The extent of postoperative collateral formation in patients with diabetes mellitus was significantly higher (p < 0.01). Postoperative clinical improvement in the diabetes group was more common after revascularization procedures (p < 0.05), and the diabetes group had lower modified Rankin Scale scores (p < 0.05) in comparison with the nondiabetes group. Late postoperative stroke and posterior cerebral artery involvement were identified as predictors of unfavorable clinical outcome in both groups, while T2DM was associated with a favorable clinical outcome. cONcluSiONS Encephaloduroarteriosynangio...

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“…Therefore, the postsurgical outcome of neurocognitive function is of interest not only to surgeons but also to patients and parents. Clinical research on the outcome of MMD treatment has examined the degree of revascularization, disappearance of TIAs and general clinical outcome, evaluated by grading scales, such as the modified Rankin Scale [4,5,6]. Previous reports focusing on neurocognitive issues have mentioned that intellectual development is impaired in a certain group of pediatric MMD patients and evaluated the prognostic factors that would be instrumental in determining the postoperative intellectual outcome.…”

Section: Introductionmentioning

confidence: 99%

Neurocognitive Profiles of Children with Moyamoya Disease before and after Surgical Intervention

Lee

Phi²,

Wang³

et al. 2010

Cerebrovasc Dis

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Background: Clinical research on moyamoya disease (MMD) has focused on symptomatic outcome such as transient ischemic attacks. Neurocognitive function in children critically affects social outcome and is closely related to quality of life. This study is the first to analyze the neurocognitive profiles of children with MMD before and after surgery. Methods: Sixty-five patients were selected out of 137 who underwent surgery for MMD between 2006 and 2008. The preoperative and postoperative neurocognitive function was tested using the Korean version of the Wechsler Intelligence Scale for Children-Revised (KEDI-WISC-R) and the Bender Gestalt Test (BGT). Pre- and postoperative profiles of patients with or without major infarctions were compared. Patients with borderzone infarctions were analyzed as well. Results: Preoperatively, patients had age-appropriate full-scale intelligence quotient (FSIQ) and verbal IQ (VIQ) scores, which were maintained after surgery. There was significant improvement in performance IQ (PIQ) (p = 0.01) and BGT scores postoperatively (p < 0.01). Among the subtests, Coding showed significant improvement postoperatively (p < 0.01). Preoperatively, patients with major infarctions had significantly lower FSIQ (p < 0.01), VIQ (p = 0.01) and PIQ (p < 0.01) scores compared with those without infarctions. The pre- and postoperative neurocognitive profiles of the patients with borderzone infarctions fell between those of patients with absolutely no infarctions and those of patients with major infarctions. Conclusions: Considering the natural history of MMD, which leads to a drastic decline in neurocognitive functions, the present findings indicate a role for early active surgery to save the intellectual abilities of children with MMD.

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Clinical Significance of Posterior Circulation Changes after Revascularization in Patients with Moyamoya Disease

Cited by 50 publications

References 37 publications

Clinical Features, Surgical Treatment and Long-Term Outcome in Adult Patients with Moyamoya Disease in China

Clinical Features, Surgical Treatment and Long-Term Outcome in Adult Patients with Moyamoya Disease in China

Surgical outcomes following encephaloduroarteriosynangiosis in adult moyamoya disease associated with Type 2 diabetes

Neurocognitive Profiles of Children with Moyamoya Disease before and after Surgical Intervention

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