Moyamoya Disease and Syndrome: A National Inpatient Study of Ischemic Stroke Predictors

Unda, Santiago R.; Antoniazzi, Aldana M.; Miller, Raphael; Klyde, Daniel; Javed, Kainaat; Fluss, Rose; Holland, Ryan; Ramos, Rafael De la Garza; Haranhalli, Neil; Altschul, David

doi:10.1016/j.jstrokecerebrovasdis.2021.105965

Cited by 11 publications

(8 citation statements)

References 17 publications

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“…Stroke is the main cause of mortality in conservatively treated MMD. 21 In this study, the incidence of ischemic stroke was higher than that of hemorrhagic stroke, but the lower mortality rate was lower. Thirteen patients suffered ischemic stroke events during follow-up, and 6 of 13 died as a result.…”

Section: Discussionmentioning

confidence: 51%

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Predictors of Stroke Outcomes in Conservatively Treated Patients With Moyamoya Disease: A Follow‐up MRI Study

Zhang

Liu

et al. 2023

Magnetic Resonance Imaging

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BackgroundLittle is known about the association between stroke and imaging and clinical features in conservatively treated patients with moyamoya disease (MMD).PurposeTo investigate independent risk factors for stroke in conservatively treated patients with MMD during a long‐term follow‐up.Study TypeProspective study.SubjectsOne hundred sixty conservatively managed patients with MMD (median age 46 years, 89 male).Field Strength/SequenceTime of flight, turbo inversion recovery magnitude T1WI, turbo spin echo (TSE) T2WI, echo‐planar imaging DWI, T2‐fluid attenuated inversion recovery, dynamic susceptibility contrast‐magnetic resonance imaging, and pre‐ and post‐contrast 3D TSE T1WI sequences at 3.0 Tesla.AssessmentPatients were assessed at baseline and followed yearly. Ischemic and hemorrhagic stroke incidence rates were determined. Multiple demographic, clinical (modified Rankin score [mRS]), and cerebral imaging (cerebral blood volume [CBV] and concentric enhancement of arterial wall) factors at baseline were considered as potential predictors of stroke during the follow‐up period.Statistical TestsUnivariable and multivariable Cox proportional hazards models to calculate the hazard ratios (HRs) and corresponding 95% confidence interval (CI) for stroke. Cumulative risk of stroke was estimated by the Kaplan–Meier product‐limit method. A P value <0.05 was considered statistically significant.ResultsThe median follow‐up duration was 47 months. During the follow‐up period, 18 (11.25%) patients experienced stroke events (13 [8.13%] ischemic, 5 [3.12%] hemorrhagic). Univariable analysis showed that 11 factors were significantly associated with stroke. After adjustment for clinical characteristics, multivariable analysis showed that mRS score ≥3 (HR, 1.99; 95% CI, 1.26–3.14), decreased CBV (HR, 5.31; 95% CI, 2.32–12.13), and concentric enhancement of the arterial wall (HR, 4.16; 95% CI, 1.55–11.15) were significantly associated with stroke.Data ConclusionDecreased CBV, mRS score ≥ 3, and concentric enhancement of the arterial wall were significantly associated with increased incidence of stroke in conservatively treated MMD.Evidence Level2Technical EfficacyStage 4

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Section: Discussionmentioning

confidence: 51%

“…Stroke is the main cause of mortality in conservatively treated MMD 21 . In this study, the incidence of ischemic stroke was higher than that of hemorrhagic stroke, but the lower mortality rate was lower.…”

Section: Discussionmentioning

confidence: 54%

Predictors of Stroke Outcomes in Conservatively Treated Patients With Moyamoya Disease: A Follow‐up MRI Study

Zhang

Liu

et al. 2023

Magnetic Resonance Imaging

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“…However, the association between sickle cell disease and MMS has been long recognized in Western countries with larger populations of African descent. 8,9 In this scientific statement, we will use the updated definitions and the term moyamoya vasculopathy when we are referring nonspecifically to either MMD or MMS.…”

Section: Moyamoya Syndromementioning

confidence: 99%

Adult Moyamoya Disease and Syndrome: Current Perspectives and Future Directions: A Scientific Statement From the American Heart Association/American Stroke Association

Gonzalez,

Amin-Hanjani,

Bang

et al. 2023

Stroke

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Adult moyamoya disease and syndrome are rare disorders with significant morbidity and mortality. A writing group of experts was selected to conduct a literature search, summarize the current knowledge on the topic, and provide a road map for future investigation. The document presents an update in the definitions of moyamoya disease and syndrome, modern methods for diagnosis, and updated information on pathophysiology, epidemiology, and both medical and surgical treatment. Despite recent advancements, there are still many unresolved questions about moyamoya disease and syndrome, including lack of unified diagnostic criteria, reliable biomarkers, better understanding of the underlying pathophysiology, and stronger evidence for treatment guidelines. To advance progress in this area, it is crucial to acknowledge the limitations and weaknesses of current studies and explore new approaches, which are outlined in this scientific statement for future research strategies.

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“…Given the ischemic nature of MMD and fragility of the smoky vessels, MMD patients are prone to suffer from cerebrovascular events (Yu et al, 2022 ). MMD is thus routinely classified into the following clinical subtypes including hemorrhagic, ischemic, and transient ischemic attack (TIA) types (Hirano et al, 2020 ; Unda et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Classify patients with Moyamoya disease according to their cognitive performance might be helpful in clinical and practical with support vector machine based on hypergraph

Wang

Zhang

Qian

et al. 2023

Human Brain Mapping

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Moyamoya disease (MMD) patients were now classified according to their cerebrovascular manifestations, with cognition and emotion ignored, which attenuated the therapy. The present study tried to classify them based on their cognitive and emotional performance and explored the neural basis underlying this classification using resting‐state fMRI (rs‐fMRI). Thirty‐nine MMD patients were recruited, assessed mental function and MRI scanned. We adopted hierarchical analysis of their mental performance for new subtypes. Next, a three‐step analysis, with each step consisting of 10 random cross validation, was conducted for robust brain regions in classifying the three subtypes of patients in a support vector machine (SVM) model with hypergraph of rs‐fMRI. We found three new subtypes including high depression‐high anxiety‐low cognition (HE‐LC, 50%), low depression‐low anxiety‐high cognition (LE‐HC, 14%), and low depression‐low anxiety‐low cognition (LE‐LC, 36%), and no hemorrhagic MMD patients fell into the LE‐HC group. The temporal and the bilateral superior frontal cortex, and so forth were included in all 10 randomized SVM modeling. The classification accuracy of the final three‐way classification model was 67.5% in average of 10 random cross validation. In addition, the S value between the frontal cortex and the angular cortex was positively correlated with the anxiety score and backward digit span ( p < .05). Our results might provide a new perspective for MMD classification concerning patients' mental status, guide timely surgery and suggest angular cortex, and so forth should be protected in surgery for cognitive consideration.

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Moyamoya Disease and Syndrome: A National Inpatient Study of Ischemic Stroke Predictors

Cited by 11 publications

References 17 publications

Predictors of Stroke Outcomes in Conservatively Treated Patients With Moyamoya Disease: A Follow‐up MRI Study

Predictors of Stroke Outcomes in Conservatively Treated Patients With Moyamoya Disease: A Follow‐up MRI Study

Adult Moyamoya Disease and Syndrome: Current Perspectives and Future Directions: A Scientific Statement From the American Heart Association/American Stroke Association

Classify patients with Moyamoya disease according to their cognitive performance might be helpful in clinical and practical with support vector machine based on hypergraph

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