Identification of associations and distinguishing moyamoya disease from ischemic strokes of other etiologies: A retrospective case-control study

Sutton, Cori Xiu Yue; Carrazana, Enrique; Mitchell, Catherine; Viereck, Jason; Liow, Kore; Ghaffari-Rafi, Arash

doi:10.1016/j.amsu.2022.103771

Cited by 5 publications

(5 citation statements)

References 65 publications

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“…It is therefore essential to understand whether adult MMD patients have a conspicuous vascular risk profile with regard to the factors identified so far. In smaller case–control studies with 28 and 12 MMD cases, respectively, patients showed a clustered occurrence of DM, AHT, as well as hyperlipidemia compared with non-MMA stroke collectives or healthy controls, comparable to our results 12 , 13 . In a study of another larger European MMD collective, a comparably high prevalence was reported with respect to DM (11.2%), NC (44.7%), and obesity (24.8%) 3 .…”

Section: Discussionsupporting

confidence: 91%

Vascular risk profile and changes of arterial hypertension after surgical revascularization in adult Moyamoya patients

Haas,

Wiggenhauser,

Tellermann

et al. 2024

Sci Rep

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Moyamoya disease (MMD) is a rare stenoocclusive cerebral vasculopathy often treated by neurosurgical revascularization using extracranial-intracranial bypasses to prevent ischemic or hemorrhagic events. Little is known about the vascular risk profile of adult MMD patients compared to the general population. We therefore analyzed 133 adult MMD patients and compared them with data from more than 22,000 patients from the German Health Update database. Patients with MMD showed an age- and sex-adjusted increased prevalence of arterial hypertension, especially in women between 30 and 44 years and in patients of both sexes between 45 and 64 years. Diabetes mellitus was diagnosed significantly more frequently in MMD patients with increasing age, whereas the vascular risk profile in terms of obesity, nicotine and alcohol consumption was similar to that of the general population. Antihypertensive medication was changed one year after surgical revascularization in 67.5% of patients with a tendency towards dose reduction in 43.2% of all patients. After revascularization, physicians need to be aware of a high likelihood of changes in arterial hypertension and should adjust all other modifiable systemic vascular risk factors to achieve the best treatment possible.

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Section: Discussionsupporting

confidence: 91%

Vascular risk profile and changes of arterial hypertension after surgical revascularization in adult Moyamoya patients

Haas,

Wiggenhauser,

Tellermann

et al. 2024

Sci Rep

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“…In the present study, however, hypertension was found to be associated with PIS, which might be attributed to the larger sample size in this study, the involvement of all MMD patients in Hubei province rather than only hemorrhagic patients, as well as the inclusion of all surgical procedures. The studies available have also indicated that MMD patients may have a higher odds ratio of having diabetes mellitus [27], and that the stenosis of major intracranial arteries may have an autoimmune etiology in patients with diabetes [28]. Herein, the diagnosis of diabetes was also found to be significantly associated with PIS, and the admission mRS score was a valuable component of MMD assessments.…”

Section: Discussionmentioning

confidence: 86%

Clinical Features and Risk Factors of Postoperative Stroke in Adult Moyamoya Disease

Liu,

Huang,

Zhang

et al. 2023

Brain Sciences

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Background and purpose: The clinical features of and risk factors for postoperative stroke after surgical revascularization in adult moyamoya disease (MMD) have not been fully elucidated. To this end, the baseline clinical features were hereby described, and the risk factors for postoperative stroke were determined. Methods: Data of 4078 MMD inpatients were collected retrospectively across all secondary- and higher-level hospitals of Hubei Province from January 2019 to December 2020. In accordance with inclusion and exclusion criteria, 559 adult MMD inpatients were finally enrolled. The associated characteristics and potential risk factors were analyzed, and the Kaplan–Meier risk of stroke was also calculated. Results: The patients consisted of 286 females and 273 males, with a mean age of 49.1 ± 10.0 years, all of whom had at least 1 year of follow-up (median 25.1 months). There were 356 cases of preoperative ischemic symptoms and 203 cases of preoperative hemorrhage symptoms. Indirect, direct, and combined revascularization were conducted on 97, 105 and 357 patients, respectively. Among these patients, 17 had postoperative hemorrhagic stroke (PHS), and 43 had postoperative ischemic stroke (PIS). A comparison between PHS/PIS group and control group (patients without postoperative stroke events) showed that preoperative hemorrhage was significantly associated with PHS (p = 0.003), while hypertension (p = 0.003), diabetes mellitus (p = 0.003) and modified Rankin scale (mRS) (p = 0.034) at admission were associated with a higher rate of PIS. Furthermore, preoperative hemorrhagic stroke was identified as a risk factor for PHS (odds ratio [OR], 4.229 [95% CI, 1.244–14.376]; p = 0.021), while hypertension (odds ratio [OR], 0.424 [95% CI, 0.210–0.855]; p = 0.017), diabetes mellitus (odds ratio [OR], 0.368 [95% CI, 0.163–0.827]; p = 0.016) and admission mRS (odds ratio [OR], 2.301 [95% CI, 1.157–4.575]; p = 0.017) were found to be risk factors for PIS. Conclusions: The age distribution of adult MMD patients with revascularization was predominantly concentrated within the range from 46 to 55 years. Preoperative hemorrhage events were considered the risk factor for PHS. Hypertension, diabetes and admission mRS were correlated with PIS, and were also the risk factors for PIS. These results indicated the possible contribution of enhancing systematic disease management to the prevention of postoperative cerebrovascular accidents.

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“…Clinical presentation of ischemic stroke secondary to MMD is similar to that of the non-MMD. [12] It is usually hard to differentiate from the ischemic stroke of other etiologies without imaging studies such as DSA and magnetic resonance angiography (MRA). [14] It is estimated that up to 62% of ischemic MMD are misdiagnosed, and 42.6% of MMD patients have delayed diagnosis even more than three years.…”

Section: Introductionmentioning

confidence: 99%

“…[10] HCY has been considered an independent risk factor for cerebrovascular disease, and studies have shown that HCY levels may also be potentially associated with the occurrence and prognosis of MMD. [11] Additionally, in MMD and non-MMD ischemic stroke patients, some clinical parameters such as blood pressure, blood glucose, blood lipids, past medical history, and personal medical history showed signi cant differences, [12,13] which could be used as differential indicators of MMD.…”

Section: Introductionmentioning

confidence: 99%

A Differential Diagnostic Model for Moyamoya Disease and Non- moyamoya Ischemic Stroke: A Highly Efficient Clinical Approach

Teng

Dai

Liu

et al. 2023

Preprint

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Purpose: Many moyamoya disease (MMD) ischemic strokes were misdiagnosed and could not be treated effectively. To address this question, we aimed to screen easily obtainable clinical variables to construct a differential diagnostic model between MMD and non-MMD ischemic stroke. Methods: A total of 300 patients (150 MMD and 150 non-MMD ischemic strokes) in Henan Provincial People's Hospital were selected and divided into training (210) and validation cohorts (90). Binary logistic regression analysis, lasso regression, and support vector machine (SVM) were used to construct the diagnostic model. The optimal model was visualized by nomograms, and the discriminant ability of the nomogram was tested in the training and validation cohorts, respectively. Results: Among the three models, binary logistic regression has the most significant C statistic (0.87 and 0.88) in the training cohort and validation cohort, respectively. The variables that showed a significant difference in the multivariate logistic regression analysis were systolic blood pressure (SBP), total cholesterol (TC), albumin (ALB), free triiodothyronine (FT3), homocysteine (HCY), and age. The Hosmer-Lemeshow test P values of nomograms in the training and validation cohorts were 0.28 and 0.19, respectively, and the calibration curves were well corrected. Patients with nomogram scores below or above 168 were considered to have a low or high risk of ischemic stroke in MMD, respectively. Conclusion:Using nomograms to identify MMD and non-MMD ischemic stroke, the model has been validated to have a good discriminatory ability in both the training and validation cohorts, improving clinicians’ awareness of MMD ischemic stroke.

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Identification of associations and distinguishing moyamoya disease from ischemic strokes of other etiologies: A retrospective case-control study

Cited by 5 publications

References 65 publications

Vascular risk profile and changes of arterial hypertension after surgical revascularization in adult Moyamoya patients

Vascular risk profile and changes of arterial hypertension after surgical revascularization in adult Moyamoya patients

Clinical Features and Risk Factors of Postoperative Stroke in Adult Moyamoya Disease

A Differential Diagnostic Model for Moyamoya Disease and Non- moyamoya Ischemic Stroke: A Highly Efficient Clinical Approach

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