Predominant Involvement of Ipsilateral Anterior and Posterior Circulations in Moyamoya Disease

Mugikura, Shunji; Takahashi, Satoshi; Higano, Shuichi; Shirane, Reizo; Sakurai, Yasuhisa; Yamada, Satoshi

doi:10.1161/01.str.0000016828.62708.21

Cited by 78 publications

(66 citation statements)

References 8 publications

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“…Moyamoya staging is based mainly on angiographically observed changes in the severities of steno-occlusive lesions (Suzuki and Takaku, 1969;Mugikura et al, 2002). However, until now, no study has addressed the blood markers associated with MMD stage in adult patients.…”

Section: Discussionmentioning

confidence: 99%

Circulating Endothelial Progenitor Cells as a Pathogenetic Marker of Moyamoya Disease

Jung

Chu

Park

et al. 2008

J Cereb Blood Flow Metab

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Moyamoya disease (MMD) is an unusual form of chronic cerebrovascular occlusive disease that involves the formation of characteristically abnormal vessels. Recent studies have reported that colony-forming unit (CFU) and outgrowth cells represent a subpopulation of endothelial progenitor cells (EPCs). Here, we attempted to determine the significance of CFU number and outgrowth cell yield in MMD. Endothelial progenitor cells were isolated from the blood of 24 adult MMD patients and from 48 age-and risk factor-matched control subjects. After 7 days of culture, CFUs were determined, and yields of outgrowth cells were measured during 2 months of culture. The EPC function was also evaluated using matrigel plate assays. It was found that CFU numbers were significantly lower in MMD patients than in controls. Moreover, during long-term culture, outgrowth cells were isolated from only 10% of control subjects but from 33% of MMD patients, and CFU numbers and tube formation were found to be lower in advanced MMD cases than in those with early stage disease, whereas outgrowth cells were more frequently detected in those with early MMD and moyamoya vessels than in those with advanced disease. These characteristics of circulating EPCs reflect mixed conditions of vascular occlusion and abnormal vasculogenesis during the pathogenesis of MMD.

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Section: Discussionmentioning

confidence: 99%

Circulating Endothelial Progenitor Cells as a Pathogenetic Marker of Moyamoya Disease

Jung

Chu

Park

et al. 2008

J Cereb Blood Flow Metab

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“…Unilateral lesion of the ICA was defined as unilateral stenosis or occlusion of the terminal portion of the ICA with the formation of moyamoya vessels accompanied by no or a subtle lesion around the contralateral terminal portion of the ICA. The severity of disease progression in the ICA was evaluated with a 4-stage system, 24 with a higher ICA stage representing more advanced stenoocclusive lesions in the anterior circulation. If the two hemispheres were classified as different ICA stages, the higher stage was recorded.…”

Section: Diagnosis and Radiological Assessmentmentioning

confidence: 99%

Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease

Funaki

Takahashi

Takagi

et al. 2013

PED

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Object In the study of pediatric moyamoya disease, information on long-term social outcomes and risk factors for unfavorable social outcomes remains insufficient. The authors analyzed the long-term results of surgical revascularization for pediatric patients with moyamoya disease to determine whether the involvement of a stenoocclusive lesion in the posterior cerebral artery (PCA), relatively common in pediatric moyamoya disease, represents an underlying predictor for unfavorable social outcomes. Methods Prospectively collected data on 61 consecutive patients with moyamoya disease who had undergone combined bypass surgery were analyzed. Neuroradiological features and other baseline clinical factors were incorporated into univariate and multivariate analyses to determine any association with an unfavorable social outcome, defined as difficulty attending regular school or obtaining regular employment. Results Posterior cerebral artery involvement detected by angiography on admission was noted in 22 (36.1%) of the 61 patients. Follow-up data were acquired in 56 patients (91.8%), and the mean follow-up period was 15.8 years. While transient ischemic attacks were eliminated in 52 (92.9%) of these 56 patients after surgery, and late-onset ischemic stroke was observed in only 1 patient during the follow-up period, 10 (17.9%) experienced an unfavorable social outcome. Although younger age at onset, longer duration between onset and surgery, infarction present on preoperative neuroradiological images, and PCA involvement had been identified as risk factors for an unfavorable social outcome in univariate analysis, only infarction present on preoperative images and PCA involvement remained statistically significant after multivariate adjustment. Conclusions Posterior cerebral artery involvement can be considered one of the underlying risk factors for unfavorable social outcome and should be studied further to improve social outcome in pediatric moyamoya disease.

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“…We used angiography to observe a total of 240 ICAs and PCAs. Using the angiographic staging system as defined by Mugikura et al, 13 we evaluated the degree of steno-occlusive ICA lesions (Stages 1-4) and checked for the existence of steno-occlusive PCA lesions. This system is a modification of Suzuki's staging system 14 and was reclassified not on the basis of the degree of the development of moyamoya vessels but mainly on the severity of steno-occlusive lesions in the proximal part of the ACA/MCA and the degree of antegrade opacification of their branches.…”

Section: Angiographic Evaluationmentioning

confidence: 99%

“…This system is a modification of Suzuki's staging system 14 and was reclassified not on the basis of the degree of the development of moyamoya vessels but mainly on the severity of steno-occlusive lesions in the proximal part of the ACA/MCA and the degree of antegrade opacification of their branches. 13 This grading system is more useful in the precise staging of ICAs on a single angiogram without the use of temporally serial angiograms as is required by Suzuki's grading system. The interobserver agreement of this staging system has been reported to be 91%.…”

Section: Angiographic Evaluationmentioning

confidence: 99%

“…The interobserver agreement of this staging system has been reported to be 91%. 13 The classification of ICA stage is as follows: Stage 1, mild to moderate stenosis around the carotid bifurcation with absent or slightly developed basal moyamoya; Stage 2, severe stenosis around the carotid bifurcation or occlusion of the proximal ACA or MCA with well-developed basal moyamoya; Stage 3, occlusion of both the proximal ACA and MCA with welldeveloped basal moyamoya; and Stage 4, complete occlusion of both the proximal ACA and MCA with absence of or a small amount of basal moyamoya. 13 None of the patients had undergone previous surgical treatment.…”

Section: Angiographic Evaluationmentioning

confidence: 99%

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Assessment of the difference in posterior circulation involvement between pediatric and adult patients with moyamoya disease

Hishikawa¹,

Tokunaga²,

Sugiu³

et al. 2013

JNS

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Object. There is no description of the change in the posterior cerebral artery (PCA) in the diagnostic criteria of moyamoya disease (MMD). However, PCAs are often involved in the clinical setting, and an understanding of the significance of PCA lesions is therefore of great importance when evaluating the disease progression and predicting prognosis. The aim of this study was to assess the difference in posterior circulation involvement in pediatric and adult patients with MMD.Methods. The records of 120 consecutive patients with MMD were reviewed. The clinical manifestations at diagnosis were evaluated on the basis of symptoms and CT and MRI findings. The degree of steno-occlusive internal carotid artery (ICA) lesions and the existence of steno-occlusive PCA lesions were evaluated by observing a total of 240 ICAs and PCAs on angiography. Angiographic correlation between anterior and posterior circulation was assessed in pediatric and adult patients with MMD.Results. Seventeen (26%) of 66 pediatric patients and 18 (33%) of 54 adult patients exhibited steno-occlusive PCA lesions. There was no significant difference in the prevalence of PCA lesions between pediatric and adult patients with MMD (p = 0.36). The prevalence of infarction in pediatric and adult patients with PCA involvement was significantly higher than that in pediatric and adult patients without PCA involvement (p = 0.0003 and p = 0.003, respectively). There was no significant difference in the distribution of infarction areas between pediatric and adult patients with PCA involvement (p = 0.62). On the basis of the staging system used, steno-occlusive lesions in ICAs ipsilateral to PCAs with lesions were in significantly advanced stages compared with lesions in ICAs ipsilateral to PCAs without lesions in both pediatric and adult cases (p < 0.0001 and p = 0.0008, respectively). Pediatric patients had less advanced steno-occlusive lesions in ICAs ipsilateral to PCAs with lesions compared with adults (p < 0.05).Conclusions. The clinical significance of posterior circulation involvement in MMD was similar between pediatric and adult patients. The only significant difference was that less advanced ICA lesions could complicate posterior circulation involvement in pediatric patients.

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Predominant Involvement of Ipsilateral Anterior and Posterior Circulations in Moyamoya Disease

Abstract: In pediatric-onset moyamoya disease, asymmetrical involvement of bilateral ICAs and PCAs was common, and the ipsilateral ICA and PCA tended to be predominantly involved.

Cited by 78 publications

References 8 publications

Circulating Endothelial Progenitor Cells as a Pathogenetic Marker of Moyamoya Disease

Circulating Endothelial Progenitor Cells as a Pathogenetic Marker of Moyamoya Disease

Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease

Assessment of the difference in posterior circulation involvement between pediatric and adult patients with moyamoya disease

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