Long-term outcomes of moyamoya disease versus atherosclerosis-associated moyamoya vasculopathy using high-resolution MR vessel wall imaging

Abstract

ObjectivesWe aimed to compare the long-term outcomes and surgical benefits between moyamoya disease (MMD) and atherosclerosis-associated moyamoya vasculopathy (AS-MMV) using high-resolution MRI (HRMRI).MethodsMMV patients were retrospectively included and divided into the MMD and AS-MMV groups according to vessel wall features on HRMRI. Kaplan-Meier survival and Cox regression were performed to compare the incidence of cerebrovascular events and prognosis of encephaloduroarteriosynangiosis (EDAS) treatment between MMD and AS-MMV.ResultsOf the 1173 patients (mean age: 42.4±11.0 years; male: 51.0%) included in the study, 881 were classified into the MMD group and 292 into the AS-MMV group. During the average follow-up of 46.0±24.7 months, the incidence of cerebrovascular events in the MMD group was higher compared with that in the AS-MMV group before (13.7% vs 7.2%; HR 1.86; 95% CI 1.17 to 2.96; p=0.008) and after propensity score matching (6.1% vs 7.3%; HR 2.24; 95% CI 1.34 to 3.76; p=0.002). Additionally, patients treated with EDAS had a lower incidence of events than those not treated with EDAS, regardless of whether they were in the MMD (HR 0.65; 95% CI 0.42 to 0.97; p=0.043) or AS-MMV group (HR 0.49; 95% CI 0.51 to 0.98; p=0.048).ConclusionsPatients with MMD had a higher risk of ischaemic stroke than those with AS-MMV, and patients with both MMD and AS-MMV could benefit from EDAS. Our findings suggest that HRMRI could be used to identify those who are at a higher risk of future cerebrovascular events.

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

“…Remarkably, we also found a significant difference of AHT compared the normal population, which became apparent even earlier in female than in male MMD patients. With 39.2% in 881 patients, Lu et al even found a comparably high prevalence of AHT in the Chinese cohort studied 28 . Kraemer et al found an even higher prevalence of AHT in a European collective, with 50.2% and 54.4% in MMA and MMD, respectively 3 .…”

Ischemic stroke and hypertension in a child — a case report of two patients

“…Feghali et al reported that MMS patients were younger and less likely to be female; complications of direct or indirect bypass surgeries were more common in MMD than in MMS (33%, 16%, respectively); stroke-free survival time after diagnosis was similar in both groups (3.7 strokes per 100 patients in MMD and 3.5/100 in MMS); MMD patients were more likely to undergo revascularization surgery compared to MMS patients (62% vs. 44%) [25]. On the other hand, a 2023 paper comparing patients with MMD with patients with atherosclerosis-associated moyamoya vasculopathy (AS-MMV), reports that over a 4-6-year follow-up period, patients with MMD were more likely to present cerebrovascular events than patients with AS-MMV [31]. The pathophysiology of both MMD and MMS is complex and includes various genetic, inflammatory, and other environmental components [32][33][34].…”

High-resolution magnetic resonance vessel wall imaging provides new insights into Moyamoya disease

“…A patient was diagnosed with MMD when at least two of the following three HR-VWI features were found in the affected segment of the ICA terminal segment or the MCA/ACA proximal segment: (1): No eccentric wall enhancement ( Wu et al, 2021 ), (2): Vessel external diameter reduction ( Kuroda et al, 2022 ), (3): uniform signal ( Yang et al, 2021 ; Lu et al, 2023b ). Eccentric wall enhancement refers to eccentric or focal wall enhancement evident on HR-VWI.…”

“…The latest research progress of HR-VWI in MMD shows that it is superior to other examination methods in MMD diagnosis, disease course detection, treatment, and prognosis evaluation ( Das et al, 2023 ; Lu et al, 2023b ; Yu et al, 2023 ). At present, the clinical examination items (DSA/CTA or MRA) can only detect the degree of lumen stenosis, but cannot distinguish the disease type.…”