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Velo M, Grasso G, Fujimura M, Torregrossa F, Longo M, Granata F, Pitrone A, Vinci SL, Ferraù L, La Spina P. Moyamoya Vasculopathy: Cause, Clinical Manifestations, Neuroradiologic Features, and Surgical Management. World Neurosurg 2022; 159:409-425. [PMID: 35255640 DOI: 10.1016/j.wneu.2021.11.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022]
Abstract
In moyamoya disease, the progressive occlusion of the distal portion of the internal carotid artery and its major branches is typically responsible for the formation of an extensive network of collateral vessels at the base of the brain. When moyamoya collateral network develops in association with various systemic or acquired diseases, the term moyamoya syndrome is used to denote this phenomenon. Sudden changes in the supraclinoid internal carotid artery and middle cerebral artery can be recognized with noninvasive neurovascular imaging techniques, which also allow a differential diagnosis with similar diseases such as degenerative steno-occlusive disease, cerebral vasculitis, and twig-like middle cerebral artery. Once the diagnosis is established, the definitive treatment for moyamoya disease is surgical revascularization, with the goal of increasing cerebral blood flow and preventing recurrent stroke. We provide a comprehensive review of the clinical and radiologic features in moyamoya vasculopathy along with its surgical management.
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Affiliation(s)
- Mariano Velo
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Giovanni Grasso
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advance Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Fabio Torregrossa
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advance Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Marcello Longo
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Francesca Granata
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy.
| | - Antonio Pitrone
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Ludovica Ferraù
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolino La Spina
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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McKenna B, Flynn P, Kirkpatrick PJ, McVerry F, McCarron MO. Intracranial bleeding from collaterals following carotid artery occlusion. Pract Neurol 2016; 16:150-2. [PMID: 26740380 DOI: 10.1136/practneurol-2015-001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 11/04/2022]
Affiliation(s)
| | - Peter Flynn
- Department of Neuroradiology, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Peter J Kirkpatrick
- University Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
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Kase CS, Shoamanesh A, Greenberg SM, Caplan LR. Intracerebral Hemorrhage. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Tanaka M, Sakaguchi M, Miwa K, Kitagawa K. Cerebral microbleeds in patients with moyamoya-like vessels secondary to atherosclerosis. Intern Med 2012; 51:167-72. [PMID: 22246484 DOI: 10.2169/internalmedicine.51.6429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Hemorrhagic risk is unknown in patients with moyamoya-like vessels associated with atherosclerotic intracranial cerebral artery occlusion. This study was undertaken to investigate the association between moyamoya-like vessels and cerebral microbleeds (CMBs) in patients with atherosclerotic steno-occlusive disease. METHODS The study population comprised 34 patients with steno-occlusive lesions in the intracranial cerebral artery caused by atherosclerosis. We evaluated the presence of moyamoya-like vessels at the base of the brain by cerebral angiography, and the presence of CMBs by T2*-weighted MRI. Patients were divided into 2 groups: those with and those without moyamoya-like vessels; clinical histories and the incidence of CMBs were compared between the groups. RESULTS Sixteen patients had moyamoya-like vessels. Twelve of 16 patients with moyamoya-like vessels had a history of ischemic stroke or transient ischemic attack, whereas only 1 patient had a history of symptomatic cerebral hemorrhage. The incidence of CMBs did not differ between the 2 groups (31% vs. 28%, p=0.82). The location of CMBs varied and was not associated with the site of moyamoya-like vessels. CONCLUSION CMBs were not associated with moyamoya-like vessels in patients with atherosclerotic cerebral artery occlusion. These patients may not have a high risk of cerebral hemorrhage.
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Affiliation(s)
- Makiko Tanaka
- Department of Neurology, Osaka University Graduate School of Medicine, Japan.
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Kase CS, Greenberg SM, Mohr J, Caplan LR. Intracerebral Hemorrhage. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ashley WW, Zipfel GJ, Moran CJ, Zheng J, Derdeyn CP. Moyamoya phenomenon secondary to intracranial atherosclerotic disease: diagnosis by 3T magnetic resonance imaging. J Neuroimaging 2009; 19:381-4. [PMID: 19021845 DOI: 10.1111/j.1552-6569.2008.00272.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Moyamoya phenomenon occurs in response to an occlusive vasculopathy affecting the distal internal carotid artery and its proximal branches. The nature of the occlusive vasculopathy is unknown in most patients. We present a patient in whom 3T magnetic resonance imaging was used to examine the arterial wall at the site of occlusion in a patient with unilateral moyamoya phenomenon. Signal characteristics were consistent with atherosclerotic disease. 3T magnetic resonance imaging may be useful for distinguishing the underlying etiology of moyamoya phenomenon in some patients.
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Affiliation(s)
- William W Ashley
- Washington University School of Medicine, Department of Neurological Surgery, St Louis, MO 63110, USA
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Maeda Y, Nomura S, Kurokawa T, Ishihara H, Harada K, Yoneda H, Kato S, Fujisawa H, Suzuki M. Cerebrovascular moyamoya disease in a 5-year-old girl who underwent interruption of the right common carotid artery in the neonatal period. J Neurosurg Pediatr 2009; 3:316-9. [PMID: 19338411 DOI: 10.3171/2008.12.peds08221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report on the case of a girl with cerebrovascular moyamoya disease born with severe respiratory failure caused by a congenital diaphragmatic hernia. Cardiopulmonary management included extracorporeal membrane oxygenation until the diaphragm defect was repaired. The right common carotid artery (CA) was interrupted and cannulated for extracorporeal membrane oxygenation. When she was 5 years of age, the patient experienced ischemic symptoms in her right extremities. Angiography revealed stenosis of the terminal portion of the internal CA (ICA) with the development of moyamoya vessels on the left side of the brain; the right ICA was supplied by extracranial anastomotic arteries. Indirect extracranial-intracranial bypass surgery was performed in the left hemisphere, and the hypoperfusion improved. The same change in the intracranial ICA with the development of moyamoya vessels occurred on her right side when she was 7 years old. Decreased cerebral blood flow occurred twice, and the moyamoya vessels developed to compensate for the cerebral ischemia. However, the occlusion of the extracranial common CA in infancy induced extracranial anastomosis rather than moyamoya vessel proliferation, and collateral circulation was formed at the lesion site. This finding indicates that neoangiogenesis requires both cerebral ischemia and growth factors derived from the lesion.
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Affiliation(s)
- Yoshihiko Maeda
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
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Furuse M, Shinichi W, Suyama Y, Takahashi K, Kajikawa H. Ischaemia-induced vascular vulnerability resulting in intracerebral haemorrhage with ipsilateral internal carotid artery occlusion. Neurol Sci 2008; 29:367-9. [PMID: 18941943 DOI: 10.1007/s10072-008-0998-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 07/11/2008] [Indexed: 11/26/2022]
Abstract
Intracerebral haemorrhage accompanied with cervical internal carotid artery (ICA) occlusion on the same side without moyamoya-like vessels is rare. A 73-year-old man with left ICA occlusion and no presence of moyamoya disease criteria underwent xenon-enhanced computed tomography with acetazolamide challenge test. The findings showed hypoperfusion and no vasoreactivity in the territory of the left middle cerebral artery. During follow-up he suffered bleeding in the left frontoparietal lobe. Cerebral angiography showed left ICA occlusion and cross flow via the anterior communicating artery without moyamoya vessels. Long-term ischaemia would make perforating or anastomotic arteries vulnerable. These arteries were easily ruptured by hypertension, resulting in intracerebral haemorrhage.
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Affiliation(s)
- Motomasa Furuse
- Department of Neurosurgery, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, Japan.
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Ueno M, Uchino A, Egashira R, Nomiyama K, Takase Y, Kudo S. Middle cerebral artery occlusion causing intracerebral hemorrhage: radiologic findings. Neuroradiol J 2007; 20:265-70. [PMID: 24299664 DOI: 10.1177/197140090702000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 04/22/2007] [Indexed: 11/17/2022] Open
Abstract
Middle cerebral artery (MCA) occlusion usually leads to cerebral infarction but rarely causes cerebral hemorrhage without infarction. We retrospectively investigated the unique radiographic manifestations in cases of cerebral hemorrhage without infarction. Computed tomography (CT) and angiographic images obtained in four patients (aged 26 to 70 years) with MCA occlusion associated with intracerebral hemorrhage were reviewed. Two patients also underwent magnetic resonance imaging (MRI), and one of these underwent magnetic resonance angiography as well; these images were also examined. Cranial CT revealed periventricular hemorrhage with ventricular penetration in one patient and with putaminal penetration in two. Solitary ventricular hemorrhage was found in the fourth patient. Angiography showed ipsilateral occlusion at the M1 portion of the MCA, accompanied by moyamoya-like vessels. No aneurysm or arteriovenous malformation was detected. MRI showed absence of the flow void in the affected MCA and an abnormal flow void in dilated collateral vessels in the basal ganglia. MCA occlusion can cause periventricular or ventricular hemorrhage, which appears to result from bleeding from fragile dilated collateral vessels and, thus, to have an etiology similar to that of adult moyamoya disease. MRI shows promise as a tool for evaluating the occlusion site.
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Affiliation(s)
- M Ueno
- Department of Radiology, Saga Medical School; Nabeshima, Saga, Japan -
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Takekawa Y, Umezawa T, Ueno Y, Sawada T, Kobayashi M. Pathological and immunohistochemical findings of an autopsy case of adult moyamoya disease. Neuropathology 2004; 24:236-42. [PMID: 15484702 DOI: 10.1111/j.1440-1789.2004.00550.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Moyamoya disease is vaso-occlusive disease involving the arteries of the circle of Willis that is accompanied by a compensatory recruitment of a vascular network. The pathological and immunohistochemical findings of an autopsy case of hemorrhagic moyamoya disease in a 69-year-old woman are described in the present report. The autopsy findings of the brain revealed cerebral and intraventricular hemorrhage with edema. The left anterior cerebral artery, bilateral middle cerebral arteries and left posterior cerebral artery were marked narrowing, and the other arteries revealed mild narrowing. Microscopically, the arteries of the circle of Willis showed narrowed lumen, fibrocellular intimal thickening, marked tortuousness of internal elastic lamina and attenuation of media. The thickened intima was composed of smooth muscle cells. The vessels with dilated or irregular-shaped lumen suggested abnormal vascular networks demonstrated by angiography. In this case, no correlation between the abnormal vascular network and expression of VEGF or VEGF receptor was disclosed. It was hypothesized that abnormal vascular networks might be composed of collateral vessels in relation to various pathological changes of the arteries, such as occlusion and stenosis, and intracranial hemorrhage in patients with moyamoya disease might occur as a result of rupture of arteries including abnormal vascular networks.
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Affiliation(s)
- Yoshinori Takekawa
- Department of Pathology, Yokosuka Municipal Hospital, Yokosuka-City, Kanagawa, Japan.
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Horn P, Pfister S, Bueltmann E, Vajkoczy P, Schmiedek P. Moyamoya-like vasculopathy (moyamoya syndrome) in children. Childs Nerv Syst 2004; 20:382-91. [PMID: 15127215 DOI: 10.1007/s00381-004-0960-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2004] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A large variety of inherited or acquired childhood disorders and conditions may present in conjunction with progressive bilateral stenosis and/or occlusion of the terminal segments of the internal carotid artery. In addition, the development of pathological collateral vessels can be observed in the vicinity of the steno-occlusive changes in these patients. This condition is known as moyamoya-like (MML) vasculopathy. The natural history, the angiographic appearance, and the pathology of MML vasculopathy probably differ from those of definite moyamoya disease. Adequate cerebral vascular imaging should be considered in all pediatric patients with inherited or acquired systemic disorders and symptoms attributable to cerebral ischemia. CASES AND DISCUSSION We present four pediatric cases of MML vasculopathy, and outline the etiology, the current classification, and the therapeutic approaches for this heterogeneous disease entity.
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Affiliation(s)
- Peter Horn
- Department of Neurosurgery, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Doblas P, Barber M, Eguiluz I, Valdivia E, Andérica J, Aguilera I, Suárez M, Luna S, Abehsera M. Enfermedad de Moya-Moya y gestación. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2002. [DOI: 10.1016/s0210-573x(02)77153-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Horowitz DR, Sheinart KF, Bederson JB. Spontaneous caudate hemorrhage associated with ingestion of a decongestant containing phenylpropanolamine. J Stroke Cerebrovasc Dis 1999; 8:91-3. [PMID: 17895147 DOI: 10.1016/s1052-3057(99)80061-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/1998] [Accepted: 10/22/1998] [Indexed: 11/19/2022] Open
Abstract
Intracerebral hemorrhage has been associated with phenylpropanolamine, a sympathomimetic agent contained in many over-the-counter medications. Caudate hemorrhage is infrequent, usually related to hypertension, and has not been reported following ingestion of medications containing phenylpropanolamine. We report an unusual case of caudate hemorrhage which developed in a patient taking an over-the-counter nasal decongestant containing phenylpropanolamine.
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Affiliation(s)
- D R Horowitz
- Department of Neurology, The Mount Sinai School of Medicine, New York, NY, USA
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Takase K, Kashihara M, Hashimoto T. Transcranial Doppler ultrasonography in patients with moyamoya disease. Clin Neurol Neurosurg 1997; 99 Suppl 2:S101-5. [PMID: 9409416 DOI: 10.1016/s0303-8467(97)00066-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study included 17 patients (five men and 12 women) with clinical diagnosis of Moyamoya disease from conventional angiograms. Bilateral basal arteries were measured by the transtemporal approach with a 2 MHz pulsed Doppler instrument (TC-2 64B EME). In 28 out of the 34 basal arteries (82.4%), reliable recordings were obtained. These transcranial Doppler ultrasonography (TCD) findings were classified into three patterns: (1) High-high pattern; the mean cerebral blood flow velocity (CBFV) was increased throughout the basal arteries by over 70 cm/s (seven arteries, 25.0%); (2) high-low pattern; the mean CBFV was fastest (over 70 cm/s) at the ICA or proximal MCA and the mean CBFV decreased remarkably distally (15 arteries, 53.6%); and (3) low-low pattern; the mean CBFV was less than 40 cm/s throughout the basal arteries (arteries, 15.4%). These CBFV patterns as assessed by TCD are compared with the patients age, clinical symptoms and angiographical stagings (Suzuki's criteria). The high-high pattern on TCD was predominantly seen in the younger patients and in the earlier stages of the disease. The high-low pattern was the most common pattern of CBFV as assessed by TCD in Moyamoya patients. The low-low pattern on TCD was more common in the later stages following angiographic evaluation by Suzuki's criteria. The above patterns based on TCD findings show a good correlation with the age of the patient and the clinical diagnosis at the onset. TCD appears to be very useful in the evaluation of patients with Moyamoya disease.
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Affiliation(s)
- K Takase
- Department of Neurosurgery, Tokushima Prefectural Central Hospital, Japan
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Natori Y, Ikezaki K, Matsushima T, Fukui M. 'Angiographic moyamoya' its definition, classification, and therapy. Clin Neurol Neurosurg 1997; 99 Suppl 2:S168-72. [PMID: 9409430 DOI: 10.1016/s0303-8467(97)00052-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Are there any differences between probable Moyamoya disease and unilateral Moyamoya disease? What kinds of differences exist between definite and probable Moyamoya disease? Furthermore, according to the diagnostic criteria of Moyamoya disease, patients with systemic disorders and angiographic features similar to those of Moyamoya disease can not be diagnosed as Moyamoya disease. How should we call these? Such patients have been reported as 'Moyamoya syndrome,' 'quasi-Moyamoya disease', 'akin-Moyamoya disease'. etc. These variations of terminology including unilateral or probable Moyamoya disease have thus led to as state of confusion. In this study the previously reported cases in the literature were surveyed to clarify how these terms have been used and how we should use them correctly in the future. Since the diagnostic criteria of this disease are mainly based on angiographic findings, the term Moyamoya 'syndrome' should not be used. A unilateral involvement without any known cause should be called 'probable.' Because some systemic diseases commonly associated with Moyamoya disease might be genetically linked, it is better to avoid using such vague expressions as 'quasi', 'akin', or 'pseudo.' There might be a coexistence of two diseases. It is therefore better to simply state that the angiographic findings are similar to Moyamoya disease, or a systemic disease with 'angiographic Moyamoya' until the etiology of the Moyamoya disease is clarified.
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Affiliation(s)
- Y Natori
- Department of Neurosurgery, Kyushu University Faculty of Medicine, Fukuoka, Japan
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