Middle Cerebral Artery Stenosis Associated with Moyamoya Pattern Collateralization

Abstract

Background and Purpose: Moyamoya disease is a well described phenomenon. This pattern of collateralization associated with isolated middle cerebral artery stenosis and the natural history of this entity have not been well described. Methods: Cerebral angiograms and CT angiograms performed between August 2004 and August of 2006 demonstrating moyamoya collateralization were retrospectively reviewed. All cases of middle cerebral artery stenosis associated with a rete pattern of collateralization were included in this series. Demographic, clinical, and angiographic data were obtained. Results: There were three cases of middle cerebral artery stenosis associated with a moyamoya pattern of collateralization. The average age of the patients was 36-years old, 2 were male, and all were Caucasian. All patients presented with ischemic symptoms. The average degree of stenosis was 91%. No stenosis was seen in the supraclinoid internal carotid arteries or elsewhere in the intracranial vasculature. Conclusion: We describe an unusual pattern of anastomosis associated with isolated severe middle cerebral artery stenosis or occlusion in Caucasians.

Middle Cerebral Artery Occlusion with Moyamoya-Like Vessels and Aneurysms

“…An intracranial bypass and microaneurysmal clipping were performed with a good outcome. nese patients 2,[4][5][6][7] . Most patients with isolated MCA steno-occlusive disease do not have severe perfusion impairment unless they have another intracranial vascular occlusion 8,9 , Moreover, Kato et al 3 , by PET examinations, showed significant perfusion impairment in patients with occlusion of the middle cerebral artery and moyamoya phenomenon compared with patients without moyamoya vessels.…”

Angiogenesis in Steno-Occlusive Vasculopathies as a Common Pathway for Intracranial Haemorrhage

“…Bleeding usually occurs in the fourth decade of life. The moyamoya collateral pattern has also been described in a more focal pattern in relation to MCA stenosis in two reports 14,15 . Rupture of dilated collateral arteries was believed to be the cause of haemorrhage in these circumstances.…”

A Case of Isolated Middle Cerebral Artery Stenosis with Hemichorea and Moyamoya Pattern Collateralization

“…Only one report has suggested that it might be an initial feature of MMD 5. Some cases with MCA stenosis associated with moyamoya pattern collateralization were reported, but the progression of a stenosis from MCA to other intreacranial vessel was not documented 6,8. MMD is a chronic, occlusive cerebrovascular disease with bilateral stenosis of the distal intracranial ICA, extending to the anterior and middle arteries with extensive collateral network 10.…”

“…A few older patients with MCA stenosis with no ICA stenosis from a previous study showed hemichorea, but these patients had typical stroke risk factors 7,8. MCA stenosis associated with Moyamoya pattern collateralization were reported, but the progression of a stenosis from MCA to other intreacranial vessel was not documented 6,8…”

“…There have been only a few young cases showing isolated MCA stenosis with no other medical condition 4–6. Its etiology and an association with MMD remain unclear.…”