Intracranial Hemodynamic Changes During Adult Moyamoya Disease Progression

Abstract

Background and purpose: This study evaluated the changes in blood flow velocity in the anterior and posterior intracranial circulations according to the progression of moyamoya disease in adult patients.Methods: We evaluated Suzuki's angiographic stage and mean blood flow velocity (MBFV) changes in intracranial vessels from both sides in 19 adult moyamoya patients. We then analyzed the linearity of MBFV changes from early to late moyamoya stages in each intracranial vessel using piecewise linear regression models.Results: The MBFV in the middle cerebral artery, terminal internal carotid artery, and anterior cerebral artery increased non linearly until stage III, and then decreased progressively up to stage VI. The ophthalmic artery also showed nonlinear velocity changes, with an increase in MBFV up to stage IV, followed by a decrease in MBFV up to stage VI. The MBFV of the basilar artery increased linearly from a normal velocity at an early moyamoya stage to a stenotic velocity at a late stage. There was no statistically significant regression model for the relationship between the MBFV in the posterior cerebral artery and moyamoya stage.Conclusions: The nonlinear and/or linear MBFV changes associated with variable intracranial vessels might be useful in initial and follow-up evaluations of different stages of moyamoya disease.

The different infarct patterns between adulthood-onset and childhood-onset moyamoya disease

“…Leptomeningeal collaterals from the posterior cerebral artery (PCA), which were scant during the early stages of MMD, develop prominently as the stage progresses 3. However, as the stages of MMD advance further, these collaterals decrease significantly 11. The honeycomb pattern of infarctions is known to appear in these advanced PCA stages,3 which was also demonstrated in this study.…”

Low flow velocity in the middle cerebral artery predicting infarction after bypass surgery in adult moyamoya disease

“…To the best of our knowledge, only a few studies have investigated MCA flow velocity in patients with MMD. 13,14,19 These studies have shown that the MFV in the MCA peaks at Suzuki Stage II or III and decreases with more advanced stages. Our data showed similar findings for advanced-stage (Suzuki Stage IV or V) MMDs, but high MFV peaked at an earlier MMD stage (i.e., Suzuki Stage I).…”

Transcranial Doppler Sonography in Pediatric Neurocritical Care

“…However, once baseline data are procured for each patient, flow velocities can be followed in real time for progressive stenosis and worsening perfusion. 68,69 In the postoperative period for these children, serial transcranial Doppler sonography may identify worsening cerebral perfusion from a TIA or an ischemic stroke, hyperperfusion, or vasospasm. These different flow profiles may lead to alternative strategies for BP, ventilation, and fluid management in this cohort.…”