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Garbani Nerini L, Bellomo J, Höbner LM, Stumpo V, Colombo E, van Niftrik CHB, Schubert T, Kulcsár Z, Wegener S, Luft A, Regli L, Fierstra J, Sebök M, Esposito G. BOLD Cerebrovascular Reactivity and NOVA Quantitative MR Angiography in Adult Patients with Moyamoya Vasculopathy Undergoing Cerebral Bypass Surgery. Brain Sci 2024; 14:762. [PMID: 39199456 PMCID: PMC11353214 DOI: 10.3390/brainsci14080762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/21/2024] [Accepted: 07/25/2024] [Indexed: 09/01/2024] Open
Abstract
Revascularization surgery for the symptomatic hemisphere with hemodynamic impairment is effective for Moyamoya vasculopathy patients. However, careful patient selection is crucial and ideally supported by advanced quantitative hemodynamic imaging. Recently, blood oxygenation level-dependent cerebrovascular reactivity (BOLD-CVR) and quantitative magnetic resonance angiography with non-invasive optimal vessel analysis (qMRA-NOVA) have gained prominence in assessing these patients. This study aims to present the results of BOLD-CVR and qMRA-NOVA imaging along with the changes in cerebral hemodynamics and flow status following flow augmentation with superficial temporal artery-middle cerebral artery (STA-MCA) bypass in our Moyamoya vasculopathy patient cohort. Symptomatic patients with Moyamoya vasculopathy treated at the Clinical Neuroscience Center of the University Hospital Zurich who underwent hemodynamic and flow imaging (BOLD-CVR and qMRA-NOVA) before and after bypass were included in the analysis. Reduced hemispheric volume flow rates, as well as impaired BOLD-CVR, were measured in all 12 patients with Moyamoya vasculopathy before STA-MCA bypass surgery. Following the surgical procedure, post-operative BOLD-CVR demonstrated a non-significant increase in BOLD-CVR values within the revascularized, symptomatic middle cerebral artery territory and cerebral hemisphere. The results of the statistical tests should be viewed as indicative due to the small sample size. Additionally, post-operative qMRA-NOVA revealed a significant improvement in the hemispheric volume flow rate of the affected hemisphere due to the additional bypass flow rate. Our findings affirm the presence of hemodynamic and flow impairments in the symptomatic hemisphere of the Moyamoya vasculopathy patients. Bypass surgery proves effective in improving both BOLD-CVR impairment and the hemispheric volume flow rate in our patient cohort.
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Affiliation(s)
- Loris Garbani Nerini
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
- University of Zürich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Jacopo Bellomo
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Lara Maria Höbner
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Vittorio Stumpo
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Elisa Colombo
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Tilman Schubert
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
- Department of Neuroradiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Zsolt Kulcsár
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
- Department of Neuroradiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Susanne Wegener
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Andreas Luft
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
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Bağcılar Ö, Korkmazer B, Kızılkılıç O, Işlak C. Unusual collaterals through interhemispheric connections in Moyamoya disease. Diagn Interv Radiol 2024; 30:72-73. [PMID: 37017225 PMCID: PMC10773173 DOI: 10.4274/dir.2023.232140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Ömer Bağcılar
- University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Radiology, İstanbul, Turkey
| | - Bora Korkmazer
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Radiology, Division of Neuroradiology, İstanbul, Turkey
| | - Osman Kızılkılıç
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Radiology, Division of Neuroradiology, İstanbul, Turkey
| | - Civan Işlak
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Radiology, Division of Neuroradiology, İstanbul, Turkey
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Venkatraghavan L, Rosen C, McKetton L, Poublanc J, Sobczyk O, Duffin J, Tymianski M, Fisher JA, Mikulis DJ. Brain Stress Test for Assessing Risk for Hemodynamic Stroke. Can J Neurol Sci 2024; 51:57-63. [PMID: 36624923 DOI: 10.1017/cjn.2023.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In patients with intracranial steno-occlusive disease (SOD), the risk of hemodynamic stroke depends on the poststenotic vasodilatory reserve. Cerebrovascular reactivity (CVR) is a test for vasodilatory reserve. We tested for vasodilatory reserve by using PETCO2 as the stressor, and Blood Oxygen Level Dependent (BOLD) MRI as a surrogate of blood flow. We correlate the CVR to the incidence of stroke after a 1-year follow-up in patients with symptomatic intracranial SOD. METHODS In this retrospective study, 100 consecutive patients with symptomatic intracranial SOD that had undergone CVR testing were identified. CVR was measured as % BOLD MR signal intensity/mmHg PETCO2. All patients with normal CVR were treated with optimal medical therapy; those with abnormal CVR were offered revascularization where feasible. We determined the incidence of stroke at 1 year. RESULTS 83 patients were included in the study. CVR was normal in 14 patients and impaired in 69 patients ipsilateral to the lesion. Of these, 53 underwent surgical revascularization. CVR and symptoms improved in 86% of the latter. The overall incidence of stroke was 4.8 % (4/83). All strokes occurred in patients with impaired CVR (4/69; 2/53 in the surgical group, all in the nonrevascularized hemisphere), and none in patients with normal CVR (0/14). CONCLUSION Our study confirms that CO2-BOLD MRI CVR can be used as a brain stress test for the assessment of cerebrovascular reserve. Impaired CVR is associated with a higher incidence of stroke and normal CVR despite significant stenosis is associated with a low risk for stroke.
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Affiliation(s)
| | - Casey Rosen
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Larissa McKetton
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Julien Poublanc
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Olivia Sobczyk
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - James Duffin
- Department of Physiology, The University of Toronto, Toronto, ON, Canada
| | - Michael Tymianski
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Joseph A Fisher
- Department of Anaesthesia, University Health Network, Toronto, ON, Canada
| | - David J Mikulis
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
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Vassilopoulou S, Tountopoulou A, Korompoki E, Papageorgiou G, Kasselimis D, Velonakis G, Chatziioannou A, Potagas C, Spengos K. Moyamoya Disease: Clinical and Radiological Characteristics in Adult Greek Patients. J Clin Med 2023; 12:5951. [PMID: 37762892 PMCID: PMC10531977 DOI: 10.3390/jcm12185951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND AND PURPOSE The aim of our study is to present, for the first time, the clinical, radiological, and neurocognitive characteristics of Greek adult patients with Moyamoya disease (MMD). METHODS We analyzed prospectively collected data of 12 patients referred to our department from 2004 to 2019. All patients underwent a thorough diagnostic work up, including extensive clinical, neuroradiological, and neurocognitive assessment. RESULTS Our study population consisted of 7 females and the median age at the time of the diagnosis was 43.5 years. No patient had a positive family history of the disease and roughly 50% were hypertensives. Ten patients presented with transient or permanent cerebrovascular ischemia and two patients suffered from hemorrhagic complications. The median NIHSS was 7.5 (0-23) and clinical status remained stable during follow-up with conservative treatment in most of the patients. The majority (83.3%) had bilateral disease confirmed by DSA. All lesions exclusively affected the anterior circulation, with 50% of patients presenting with stenoocclusive changes. No aneurysm or AVM were revealed. The most common neurocognitive deficits were in the executive and language domains. CONCLUSIONS Our MMD patients had a later onset of the disease and an absence of familial occurrence. The most common manifestation was ischemia, transient or permanent, and all lesions affected the anterior circulation, whereas no vascular malformations (AVM, aneurysms) were demonstrated in brain imaging. These findings in Greek patients imply a probable different, Mediterranean phenotype.
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Affiliation(s)
- Sofia Vassilopoulou
- Stroke Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Argyro Tountopoulou
- Stroke Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Eleni Korompoki
- Stroke Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Georgios Papageorgiou
- Neuropsychology and Language Disorders Unit, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (D.K.)
| | - Dimitrios Kasselimis
- Neuropsychology and Language Disorders Unit, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (D.K.)
- Department of Psychology, Panteion University of Social and Political Sciences, 17671 Athens, Greece
| | - Georgios Velonakis
- 2nd Department of Radiology, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Achilles Chatziioannou
- 1st Department of Radiology, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Constantin Potagas
- Neuropsychology and Language Disorders Unit, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (D.K.)
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Gao G, Hao F, Wang Q, Wang X, Liu S, Wang M, Guo Q, Li J, Bao X, Han C, Duan L. Surgical outcomes following encephaloduroarteriosynangiosis in moyamoya disease associated with hyperhomocysteinemia. Brain Behav 2023; 13:e3093. [PMID: 37386744 PMCID: PMC10454250 DOI: 10.1002/brb3.3093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION This study investigated the effect of indirect revascularization surgery in adult patients with moyamoya disease (MMD) complicated with hyperhomocysteinemia (HHcy), and the effect of HHcy on the progression of adult MMD. METHODS A retrospective case-control study was conducted in patients with MMD, with or without HHcy (n = 123). Postoperative collateral angiogenesis was evaluated using the Matsushima grading system and disease progression using the Suzuki staging system. Cerebral blood flow was evaluated before and after surgery using dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) and neurological function prognosis using the improved Rankin score (mRS). Univariate and multivariate logistic regression analyses were performed to determine risk factors for the clinical outcomes. RESULTS There was no significant difference in the Suzuki stage composition ratios between the HHcy group and the non-HHcy group before and after surgery. Non-HHcy patients were more likely to grow new collateral circulating vessels after encephaloduroarteriosynangiosis (EDAS). Moreover, postoperative DSC-MRI indicated that the time to peak significantly improved. CONCLUSIONS HHcy level may be a specific predictor of adverse clinical outcomes after EDAS in patients with MMD and a risk factor for poor collateral circulation and poor prognosis. Patients with MMD complicated with HHcy need to strictly control homocysteine levels before EDAS surgery.
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Affiliation(s)
- Gan Gao
- Chinese PLA Medical SchoolBeijingChina
- Department of NeurosurgeryChinese PLA General HospitalBeijingChina
| | - Fang‐bin Hao
- Chinese PLA Medical SchoolBeijingChina
- Department of NeurosurgeryChinese PLA General HospitalBeijingChina
| | - Qian‐Nan Wang
- Department of NeurosurgeryChinese PLA General HospitalBeijingChina
| | - Xiao‐Peng Wang
- Chinese PLA Medical SchoolBeijingChina
- Department of NeurosurgeryChinese PLA General HospitalBeijingChina
| | - Si‐meng Liu
- Chinese PLA Medical SchoolBeijingChina
- Department of NeurosurgeryChinese PLA General HospitalBeijingChina
| | - Min‐jie Wang
- Chinese PLA Medical SchoolBeijingChina
- Department of NeurosurgeryChinese PLA General HospitalBeijingChina
| | - Qing‐bao Guo
- Chinese PLA Medical SchoolBeijingChina
- Department of NeurosurgeryChinese PLA General HospitalBeijingChina
| | - Jing‐jie Li
- Chinese PLA Medical SchoolBeijingChina
- Department of NeurosurgeryChinese PLA General HospitalBeijingChina
| | - Xiang‐Yang Bao
- Department of NeurosurgeryChinese PLA General HospitalBeijingChina
| | - Cong Han
- Department of NeurosurgeryChinese PLA General HospitalBeijingChina
| | - Lian Duan
- Department of NeurosurgeryChinese PLA General HospitalBeijingChina
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Lucia K, Acker G, Rubarth K, Beyaztas D, Vajkoczy P. The Development and Effect of Systemic Hypertension on Clinical and Radiological Outcome in Adult Moyamoya Angiopathy Following Revascularization Surgery: Experience of a Single European Institution. J Clin Med 2023; 12:4219. [PMID: 37445259 DOI: 10.3390/jcm12134219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/10/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Patients with Moyamoya Angiopathy (MMA) display structurally altered vessels with decreased cerebral autoregulatory capacity, so aggressive lowering of systemic hypertension may aggravate ischemic symptoms, whereas uncontrolled hypertension may promote hemorrhage. This study provides an in-depth analysis of the role of hypertension in adult MMA patients including long-term analysis of clinical and radiological development. In this single-center retrospective analysis of 137 adult MMA patients with 206 surgically treated hemispheres angiographic images, clinical/operative data were reviewed and scored. Univariate Cox-regression analysis was performed to evaluate hypertension as a predictor for negative angiographic and clinical outcomes following revascularization surgery. A total of 50% of patients were being treated for hypertension prior to the first surgery. Patients with and without hypertension did not differ in terms of age, gender, diagnosis, symptom onset or disease severity (Berlin and Suzuki Grades). Although hypertension did not statistically significantly affect postoperative collaterals, moyamoya vessels or STA-MCA bypass patency, patients with hypertension showed higher rates of bypass patency and better bypass filling compared to those without hypertension. No significant differences in adverse events were found in patients with and without systemic hypertension and the presence of systemic hypertension was not found to predict negative clinical or radiological outcomes. In conclusion, the rate of systemic hypertension in MMA patients appears to be higher than the general population; however, this is not associated with an increased risk of postoperative complications or negative angiographic development following revascularization procedures. Systemic hypertension may also positively influence the rate of bypass patency and filling following revascularization procedures.
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Affiliation(s)
- Kristin Lucia
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Neurosurgery, Goethe University Hospital Frankfurt Am Main, Schleusenweg 2-16, 60528 Frankfurt Am Main, Germany
| | - Güliz Acker
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Kerstin Rubarth
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Institute of Biometrics and Clinical Epidemiology Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Institute of Medical Informatics Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Defne Beyaztas
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Shulgina AA, Lukshin VA, Usachev DY. [Variants of collateral cerebral circulation in moyamoya disease]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:20-28. [PMID: 37325823 DOI: 10.17116/neiro20238703120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Moyamoya disease is a chronic progressive cerebrovascular disease with a complex pathophysiology and unique features of neoangiogenesis. These features are still known only to a few specialists, although they determine clinical course and outcomes of disease. OBJECTIVE To determine the nature and degree of neoangiogenesis in restructuring the natural collateral circulation in patients with moyamoya disease and its effect on cerebral blood flow. The influence of collateral circulation on postoperative results and factors of its effectiveness will be analyzed in the 2nd part of the study. MATERIAL AND METHODS The study included 65 patients with moyamoya disease who underwent preoperative selective direct angiography with separate contrast enhancement of both internal, external and vertebral arteries. We analyzed 130 hemispheres. Suzuki stage of disease, pathways of collateral circulation and their relationship with reduction of cerebral blood flow and clinical manifestations were assessed. Distal vessels of the middle cerebral artery (MCA) were additionally studied. RESULTS Suzuki stage 3 was the most common (36 hemispheres, 38%). Leptomeningeal collaterals were the most common among intracranial collateral tracts (82 hemispheres, 66.1%). Extra-intracranial transdural collaterals were found in half of the cases (56 hemispheres). We observed certain changes in distal vessels of the MCA (hypoplasia of M3 branches) in 28 (20.9%) hemispheres. Suzuki stage of disease significantly determined degree of cerebral blood flow insufficiency, i.e. more severe perfusion deficit was observed at the later stages of disease. A well-developed system of leptomeningeal collaterals significantly reflected stages of compensation and subcompensation of cerebral blood flow according to perfusion data (χ2=20.394, p<0.001). CONCLUSION Neoangiogenesis is a natural compensatory mechanism in moyamoya disease designed to maintain brain perfusion under reduced cerebral blood flow. Predominant intra-intracranial collaterals are associated with ischemic and hemorrhagic events. Timely restructuring on extra-intracranial ways of collateral circulation prevents adverse manifestations of disease. Assessment and understanding of collateral circulation in patients with moyamoya disease create the prerequisites for substantiating the method of surgical treatment.
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Affiliation(s)
| | - V A Lukshin
- Burdenko Neurosurgical Center, Moscow, Russia
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Mertens R, Acker G, Kersting K, Lange C, Furth C, Beyaztas D, Truckenmueller P, Moedl L, Spruenken ED, Czabanka M, Vajkoczy P. Validation of the Berlin Grading System for moyamoya angiopathy with the use of [ 15O]H 2O PET. Neurosurg Rev 2022; 46:25. [PMID: 36574089 PMCID: PMC9794537 DOI: 10.1007/s10143-022-01920-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/05/2022] [Accepted: 11/30/2022] [Indexed: 12/28/2022]
Abstract
The Berlin Grading System assesses clinical severity of moyamoya angiopathy (MMA) by combining MRI, DSA, and cerebrovascular reserve capacity (CVRC). Our aim was to validate this grading system using [15O]H2O PET for CVRC. We retrospectively identified bilateral MMA patients who underwent [15O]H2O PET examination and were treated surgically at our department. Each hemisphere was classified using the Suzuki and Berlin Grading System. Preoperative symptoms and perioperative ischemias were collected, and a logistic regression analysis was performed. A total of 100 hemispheres in 50 MMA patients (36 women, 14 men) were included. Using the Berlin Grading System, 2 (2.8%) of 71 symptomatic hemispheres were categorized as grade I, 14 (19.7%) as grade II, and 55 (77.5%) as grade III. The 29 asymptomatic hemispheres were characterized as grade I in 7 (24.1%) hemispheres, grade II in 12 (41.4%), and grade III in 10 (34.5%) hemispheres. Berlin grades were independent factors for identifying hemispheres as symptomatic and higher grades correlated with increasing proportion of symptomatic hemispheres (p < 0.01). The Suzuki grading did not correlate with preoperative symptoms (p = 0.26). Perioperative ischemic complications occurred in 8 of 88 operated hemispheres. Overall, complications did not occur in any of the grade I hemispheres, but in 9.1% (n = 2 of 22) and 9.8% (n = 6 of 61) of grade II and III hemispheres, respectively. In this study, we validated the Berlin Grading System with the use of [15O]H2O PET for CVRC as it could stratify preoperative symptomatology. Furthermore, we highlighted its relevance for predicting perioperative ischemic complications.
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Affiliation(s)
- R Mertens
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health, BIH Academy, (Junior) Clinician Scientist Program, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G Acker
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health, BIH Academy, (Junior) Clinician Scientist Program, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Kersting
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - C Lange
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - C Furth
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - D Beyaztas
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - P Truckenmueller
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - L Moedl
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - E D Spruenken
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - M Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - P Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
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9
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Zheng S, Wang F, Cheng L, Li R, Zhang D, He W, Zhang W. Ultrasound parameters associated with stroke in patients with moyamoya disease: a logistic regression analysis. Chin Neurosurg J 2022; 8:32. [PMID: 36221122 PMCID: PMC9555074 DOI: 10.1186/s41016-022-00300-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/19/2022] [Indexed: 11/07/2022] Open
Abstract
Background Moyamoya disease can lead to stroke with devastating consequences, it is necessary to find a non-invasive and effective approach to identify the occurrence of stroke. In this study, we aim to analyze the association between ultrasound parameters and ipsilateral cerebral hemisphere stroke in patients with moyamoya disease by logistic regression analysis. Methods In this retrospective case–control study, 88 patients with MMD (153 cerebral hemispheres) hospitalized in Beijing Tiantan Hospital, Capital Medical University from November 2020 to October 2021 were analyzed. According to the occurrence of stroke, the 153 cerebral hemispheres were divided into a stroke group and a non-stroke group. Clinical data and ultrasound parameters of the ipsilateral internal carotid artery, superficial temporal artery, maxillary artery, and posterior cerebral artery were recorded. The ultrasound parameters were divided into four groups according to interquartile range, and then they were compared between the stroke group and the non-stroke group. Those with significant differences were scored by multivariate logistic regression analysis. Results There were 75 cerebral hemispheres (49.0%) in the stroke group and 78 cerebral hemispheres (51.0%) in the non-stroke group. Logistic regression analysis showed that the internal diameter of the internal carotid artery, peak systolic velocity of the internal carotid artery and peak systolic velocity of the posterior cerebral artery were independently correlated factors for stroke in patients with MMD. The fourth quartile group of the above three ultrasound parameters was taken as the reference group, and the odds ratio of the first quartile group were 11.679 (95% CI 2.918–46.749, P = 0.001), 19.594 (95% CI 4.973–77.193, P < 0.001), and 11.657 (95% CI 3.221–42.186, P < 0.001), respectively. Conclusion Ultrasound parameters are independently correlated with ipsilateral cerebral stroke in patients with MMD. Ultrasound provides a new way to identify stroke in MMD patients. Future prospective cohort studies are needed to verify the clinical value of ultrasound in identifying patients with MMD at high risk of stroke.
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Affiliation(s)
- Shuai Zheng
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai District, Beijing, 100070 People’s Republic of China
| | - Fumin Wang
- grid.411472.50000 0004 1764 1621Department of Ultrasound, Peking University First Hospital, No. 8, Xishiku street, Xicheng District, Beijing, 100034 People’s Republic of China
| | - Linggang Cheng
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai District, Beijing, 100070 People’s Republic of China
| | - Rui Li
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai District, Beijing, 100070 People’s Republic of China
| | - Dong Zhang
- grid.414350.70000 0004 0447 1045Department of Neurosurgery, Beijing Hospital, No.1, Dahua Road, Dongdan, Dongcheng District, Beijing, 100730 People’s Republic of China ,grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai District, Beijing, 100070 People’s Republic of China
| | - Wen He
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai District, Beijing, 100070 People’s Republic of China
| | - Wei Zhang
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai District, Beijing, 100070 People’s Republic of China
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10
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Waddle S, Garza M, Davis LT, Chitale R, Fusco M, Lee C, Patel NJ, Kang H, Jordan LC, Donahue MJ. Presurgical Magnetic Resonance Imaging Indicators of Revascularization Response in Adults With Moyamoya Vasculopathy. J Magn Reson Imaging 2022; 56:983-994. [PMID: 35289460 PMCID: PMC9481650 DOI: 10.1002/jmri.28156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/13/2022] [Accepted: 03/02/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Moyamoya is a progressive intracranial vasculopathy, primarily affecting distal segments of the internal carotid and middle cerebral arteries. Treatment may comprise angiogenesis-inducing surgical revascularization; however, lack of randomized trials often results in subjective treatment decisions. HYPOTHESIS Compensatory presurgical posterior vertebrobasilar artery (VBA) flow-territory reactivity, including greater cerebrovascular reactivity (CVR) and reduced vascular delay time, portends greater neoangiogenic response verified on digital subtraction angiography (DSA) at 1-year follow-up. STUDY TYPE Prospective intervention cohort. SUBJECTS Thirty-one patients with moyamoya (26 females; age = 45 ± 13 years; 41 revascularized hemispheres). METHODS Anatomical MRI, hypercapnic CVR MRI, and DSA acquired presurgically in adult moyamoya participants scheduled for clinically indicated surgical revascularization. One-year postsurgery, DSA was repeated to evaluate collateralization. FIELD STRENGTH 3 T. SEQUENCE Hypercapnic T 2 * -weighted gradient-echo blood-oxygenation-level-dependent, T2 -weighted turbo-spin-echo fluid-attenuated-inversion-recovery, T1 -weighted magnetization-prepared-rapid-gradient-echo, and T2 -weighted diffusion-weighted-imaging. ASSESSMENT Presurgical maximum CVR and response times were evaluated in VBA flow-territories. Revascularization success was determined using an ordinal scoring system of neoangiogenic collateralization from postsurgical DSA by two cerebrovascular neurosurgeons (R.V.C. with 8 years of experience; M.R.F. with 9 years of experience) and one neuroradiologist (L.T.D. with 8 years of experience). Stroke risk factors (age, sex, race, vasculopathy, and diabetes) were recorded. STATISTICAL TESTS Fisher's exact and Wilcoxon rank-sum tests were applied to compare presurgical variables between cohorts with angiographically confirmed good (>1/3 middle cerebral artery [MCA] territory revascularized) vs. poor (<1/3 MCA territory revascularized) outcomes. SIGNIFICANCE two-sided P < 0.05. Normalized odds ratios (ORs) were calculated. RESULTS Criteria for good collateralization were met in 25 of the 41 revascularized hemispheres. Presurgical normalized VBA flow-territory CVR was significantly higher in those with good (1.12 ± 0.13 unitless) vs. poor (1.04 ± 0.05 unitless) outcomes. Younger (OR = -0.60 ± 0.67) and White (OR = -1.81 ± 1.40) participants had highest revascularization success (good outcomes: age = 42 ± 14 years, race = 84% White; poor outcomes: age = 49 ± 11 years, race = 44% White). DATA CONCLUSION Presurgical MRI-measures of VBA flow-territory CVR are highest in moyamoya participants with better angiographic responses to surgical revascularization. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 4.
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Affiliation(s)
- Spencer Waddle
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Maria Garza
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Larry T. Davis
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rohan Chitale
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew Fusco
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chelsea Lee
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niral J. Patel
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lori C. Jordan
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J. Donahue
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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11
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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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12
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Nyvad J, Lerman A, Lerman LO. With a Little Help From My Friends: the Role of the Renal Collateral Circulation in Atherosclerotic Renovascular Disease. Hypertension 2022; 79:717-725. [PMID: 35135307 PMCID: PMC8917080 DOI: 10.1161/hypertensionaha.121.17960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The collateral circulation can adapt to bypass major arteries with limited flow and serves a crucial protective role in coronary, cerebral, and peripheral arterial disease. Emerging evidence indicates that the renal collateral circulation can similarly adapt and thereby limit kidney ischemia in atherosclerotic renovascular disease. These adaptations predominantly include recruitment of preexisting microvessels for arteriogenesis, with de novo vessel formation playing a limited role. Yet, adaptations of the renal collateral circulation in renovascular disease are often insufficient to fully compensate for the limited flow within an obstructed renal artery and may be hampered by the severity of obstruction or patient comorbidities. Experimental strategies have attempted to circumvent limitations of collateral formation and improve the prognosis of patients with various ischemic vascular territories. These have included pharmacological approaches such as endothelial growth factors, renin-angiotensin-aldosterone system blockade, and If-channel-blockers, as well as interventions like preconditioning, exercise, enhanced external counter-pulsation, and low-energy shock-wave therapy. However, few of these strategies have been implemented in atherosclerotic renovascular disease. This review summarizes current understanding regarding the development of renal collateral circulation in atherosclerotic renovascular disease. Studies are needed to apply lessons learned in other vascular beds in the setting of atherosclerotic renovascular disease to develop new treatment regimens for this patient group.
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Affiliation(s)
- Jakob Nyvad
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN. (J.N., L.O.L.).,Department of Nephrology and Hypertension, Aarhus University Hospital, Aarhus, Denmark (J.N.)
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. (A.L.)
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN. (J.N., L.O.L.)
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13
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Sebök M, Niftrik CHBV, Lohaus N, Esposito G, Amki ME, Winklhofer S, Wegener S, Regli L, Fierstra J. Leptomeningeal collateral activation indicates severely impaired cerebrovascular reserve capacity in patients with symptomatic unilateral carotid artery occlusion. J Cereb Blood Flow Metab 2021; 41:3039-3051. [PMID: 34112002 PMCID: PMC8545056 DOI: 10.1177/0271678x211024373] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For patients with symptomatic unilateral internal carotid artery (ICA) occlusion, impaired cerebrovascular reactivity (CVR) indicates increased stroke risk. Here, the role of collateral activation remains a matter of debate, whereas angio-anatomical collateral abundancy does not necessarily imply sufficient compensatory flow provided. We aimed to further elucidate the role of collateral activation in the presence of impaired CVR. From a prospective database, 62 patients with symptomatic unilateral ICA occlusion underwent blood oxygenation-level dependent (BOLD) fMRI CVR imaging and a transcranial Doppler (TCD) investigation for primary and secondary collateral activation. Descriptive statistic and multivariate analysis were used to evaluate the relationship between BOLD-CVR values and collateral activation. Patients with activated secondary collaterals exhibited more impaired BOLD-CVR values of the ipsilateral hemisphere (p = 0.02). Specifically, activation of leptomeningeal collaterals showed severely impaired ipsilateral hemisphere BOLD-CVR values when compared to activation of ophthalmic collaterals (0.05 ± 0.09 vs. 0.12 ± 0.04, p = 0.005). Moreover, the prediction analysis showed leptomeningeal collateral activation as a strong independent predictor for ipsilateral hemispheric BOLD-CVR. In our study, ipsilateral leptomeningeal collateral activation is the sole collateral pathway associated with severely impaired BOLD-CVR in patients with symptomatic unilateral ICA occlusion.
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Affiliation(s)
- Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niklas Lohaus
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mohamad El Amki
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Winklhofer
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Susanne Wegener
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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14
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Ogawa K, Suma T, Akimoto T, Hara M, Fujishiro M, Yoshino A, Nakajima H. Clinical Study of Cerebral Ischemia in Moyamoya Disease from the View of Development of the Anterior Choroidal Artery. J Stroke Cerebrovasc Dis 2021; 30:106078. [PMID: 34500198 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The anterior choroidal artery (AchA) is one of the collateral vessels in moyamoya disease (MMD). The incidence of cerebral ischemia in MMD was analyzed through the association between development of the AchA and advancement of MMD stage. MATERIALS AND METHODS Twelve patients of MMD with cerebral ischemia (infarction; 9 patients, transient ischemic attack; 3 patients) were enrolled. Advancement of MMD was evaluated using Suzuki's stage. The grades in Suzuki's stage were subclassified into a non-progressive stage for grades 1 and 2, and a progressive stage for grades 4 and 5. Dilatation of the AchA was judged as the presence of development of this artery. Development of the AchA was grouped into proximal type and proximal and distal type. RESULTS Most frequent locations of infarcts were the anterior and parietal lobes in 6 patients each. Development of the AchA was confirmed on the ischemic side in all patients and on the non-ischemic side in 9 patients. Development of the AchA in the progressive stage was limited in the proximal and distal type on both sides. Development of the AchA in the non-progressive stage was the proximal type on the ischemic side. CONCLUSIONS The cause of cerebral ischemia was possibly associated with inadequate blood supply of the AchA in the non-progressive stage, and the lower blood flow from the internal carotid artery (ICA) in the progressive stage. Disparity between collateral blood flow from the AchA and the blood flow from the ICA was considered to relate to incidence of cerebral ischemia in MMD.
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Affiliation(s)
- Katsuhiko Ogawa
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Takeshi Suma
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Takayoshi Akimoto
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Hara
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Midori Fujishiro
- Division of Diabetes and Metabolic Diseases, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Atsuo Yoshino
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hideto Nakajima
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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15
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Santoro JD, Lee S, Wang AC, Ho E, Nagesh D, Khoshnood M, Tanna R, Durazo-Arvizu RA, Manning MA, Skotko BG, Steinberg GK, Rafii MS. Increased Autoimmunity in Individuals With Down Syndrome and Moyamoya Disease. Front Neurol 2021; 12:724969. [PMID: 34566869 PMCID: PMC8455812 DOI: 10.3389/fneur.2021.724969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/09/2021] [Indexed: 12/31/2022] Open
Abstract
Objective: To determine if elevated rates of autoimmune disease are present in children with both Down syndrome and moyamoya disease given the high rates of autoimmune disease reported in both conditions and unknown etiology of angiopathy in this population. Methods: A multi-center retrospective case-control study of children with Down syndrome and moyamoya syndrome, idiopathic moyamoya disease, and Down syndrome without cerebrovascular disease was performed. Outcome measures included presence of autoimmune disease, presence of autoantibodies and angiopathy severity data. Comparisons across groups was performed using the Kruskal-Wallis, χ2 and multivariate Poisson regression. Results: The prevalence of autoimmune disease were 57.7, 20.3, and 35.3% in persons with Down syndrome and moyamoya syndrome, idiopathic moyamoya disease, and Down syndrome only groups, respectively (p < 0.001). The prevalence of autoimmune disease among children with Down syndrome and moyamoya syndrome is 3.2 times (p < 0.001, 95% CI: 1.82-5.58) higher than the idiopathic moyamoya group and 1.5 times (p = 0.002, 95% CI: 1.17-1.99) higher than the Down syndrome only group when adjusting for age and sex. The most common autoimmune diseases were thyroid disorders, type I diabetes and Celiac disease. No individuals with idiopathic moyamoya disease had more than one type of autoimmune disorder while 15.4% of individuals with Down syndrome and moyamoya syndrome and 4.8% of individuals with Down syndrome only had >1 disorder (p = 0.05, 95%CI: 1.08-6.08). Interpretation: This study reports elevated rates of autoimmune disease in persons with Down syndrome and moyamoya syndrome providing a nidus for study of the role of autoimmunity in angiopathy in this population.
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Affiliation(s)
- Jonathan D. Santoro
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States,Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, United States,*Correspondence: Jonathan D. Santoro
| | - Sarah Lee
- Department of Neurology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Anthony C. Wang
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Eugenia Ho
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States,Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, United States
| | - Deepti Nagesh
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States,Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, United States
| | - Mellad Khoshnood
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Runi Tanna
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Ramon A. Durazo-Arvizu
- Biostatistics Core, Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, CA, United States
| | - Melanie A. Manning
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States,Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Brian G. Skotko
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States,Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Gary K. Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Michael S. Rafii
- Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, United States,Alzheimer's Therapeutic Research Institute (ATRI), Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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16
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Pilgram-Pastor S, Chapot R, Kraemer M. The angiographic presentation of European Moyamoya angiopathy. J Neurol 2021; 269:997-1006. [PMID: 34240321 PMCID: PMC8782787 DOI: 10.1007/s00415-021-10684-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
Background and purpose Little is known about the angiographic presentation of Moyamoya angiopathy (MMA) in non-Asian patients. Methods Conventional cerebral angiograms from 155 Caucasian patients diagnosed as MMA were analyzed with respect to extracranial champagne bottle neck sign, Suzuki stages, collateral status, as well as presence of aneurysms and posterior cerebral artery stenosis. Results In 84 of 155 angiograms, the extracranial carotid artery was visualized, in 65 of them (77.4%), a champagne bottle neck sign was noted. Of the 278 analyzable hemispheres, 13.7%,11.2%, 37.8%, 27.3%, 8.6%, and 1.4% were classified as Suzuki stage I, stage II, stage III, stage IV, stage V, and stage VI, respectively. Among 280 hemispheres, in 53 hemispheres (18.9%) isolated basal collaterals (pathway I) and in 104 hemispheres (37.1%) choroidal and pericallosal collaterals (including basal collaterals, pathway II) were found. In 74 hemispheres (26.4%) ethmoidal collaterals (pathways III), and in 17 hemispheres (6.1%) vault collaterals were visualized. Patients with higher Suzuki stages IV–VI (p = 0.008) and ethmoidal collaterals (p < 0.001) suffered more often from cerebral hemorrhage. Transient ischemic attacks occurred more frequently in patients with Suzuki stage I to III (p < 0.001). In 10 of 155 patients (6.5%), the angiogram revealed a cerebral aneurysm. In 13 patients (8.4%), a stenotic P1 segment of the posterior cerebral artery was found. Conclusions This is so far the largest observational study about angiography in Caucasian European MMA patients. A comparison with Asian data indicates similarity of disease in Caucasian and Asian patients.
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Affiliation(s)
- Sara Pilgram-Pastor
- Department of Neuroradiology, Alfried Krupp Hospital, Essen, Germany
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - René Chapot
- Department of Neuroradiology, Alfried Krupp Hospital, Essen, Germany
| | - Markus Kraemer
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
- Department of Neurology, Alfried Krupp Von Bohlen Und Halbach Hospital, Alfried-Krupp-Str. 21, 45117, Essen, Germany.
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17
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Srinivasan HL, Hausman-Kedem M, Smith ER, Constantini S, Roth J. Current trends in pediatric moyamoya: a survey of international practitioners. Childs Nerv Syst 2021; 37:2011-2023. [PMID: 33694129 DOI: 10.1007/s00381-021-05074-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Moyamoya angiopathy (MM) is a chronic, progressive steno-occlusive arteriopathy of the distal internal carotid artery and its proximal branches. MM is recognized as a shared end-pathway common to a broad range of inciting pathologies, suggesting that tailored management is important. Pediatric MM differs from MM in adults. Currently, there are many uncertainties and controversies regarding the diagnosis and management of children with MM. Hence, we conducted an international survey to identify the contemporary management trends followed worldwide. METHODS A survey relating to lifestyle modifications, medical management, diagnosis, surgical management, and follow-up for pediatric MM was circulated across web-based platforms, through various international pediatric neurological and neurosurgical societies. Data collected included geographic region of practice, experience, responses to questions, and comments. RESULTS One hundred twenty-seven responses were evaluated (104 neurosurgeons and 23 neurologists, from 32 countries, across 6 continents). We found wide variations in the recommendations for management and lifestyle modification, with significant differences between regions of practice. Eighty percent recommend restrictions on physical activity, particularly for symptomatic and non-operated patients. Eighty-four percent prescribe aspirin. Sixty-five percent perform indirect revascularization. Seventy-eight percent recommend performing a staged surgery for bilateral MM. Only 26% perform acetazolamide challenge SPECT to evaluate brain perfusion. Only 15% of responders were from highly experienced centers. CONCLUSION This survey reflects the contemporary trends in management of pediatric MM, while highlighting the heterogeneity in the management approach of these patients. There is a need for multicenter, international studies to evaluate the safety, efficacy, and long-term outcome of various aspects of treatment of these patients.
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Affiliation(s)
- Harishchandra Lalgudi Srinivasan
- Pediatric Neurosurgery Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Moran Hausman-Kedem
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edward R Smith
- Pediatric Cerebrovascular Surgery, Pediatric Neurosurgery, Children's Hospital Boston/Harvard Medical School, Boston, MA, USA
| | - Shlomi Constantini
- Pediatric Neurosurgery Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Roth
- Pediatric Neurosurgery Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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18
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Kim M, Park W, Chung Y, Lee SU, Park JC, Kwon DH, Ahn JS, Lee S. Development and validation of a risk scoring model for postoperative adult moyamoya disease. J Neurosurg 2021; 134:1505-1514. [PMID: 32384266 DOI: 10.3171/2020.2.jns193221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/26/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current grading system for moyamoya disease (MMD) is focused on angiographic studies with limited clinical application. The authors aimed to determine relevant factors that may impact postoperative outcome and establish a scoring system to predict the functional outcome. METHODS Adult patients with MMD who underwent treatment between 1998 and 2016 were included. Factors such as age, sex, comorbidity, smoking, MMD family history, initial presentation, multimodal imaging modalities, and types of surgical revascularization were thoroughly reviewed. These factors were analyzed to determine possible risk factors related to unfavorable 6-month postoperative outcomes using the modified Rankin Scale (mRS) (unfavorable: mRS score ≥ 3). A scoring system was developed using these independent risk factors to predict the outcome and validated using prospectively collected data from multiple centers between 2017 and 2018. RESULTS Of 302 patients for whom applications were submitted, 260 patients (321 hemispheres) met the diagnostic criteria. In multivariate analysis, hyperlipidemia, smoking, cerebral infarction on preoperative CT or MRI, and moderately to severely reduced regional cerebrovascular reserve results from Diamox SPECT were significantly related to unfavorable outcome. The authors developed a scoring system and stratified patients into risk groups according to their scores: low-risk (score 0-3), intermediate-risk (score 4-6), and high-risk (score 7-9) groups. This model demonstrated both good discrimination and calibration using C-statistics and the Hosmer-Lemeshow goodness-of-fit test showing 0.812 (95% CI 0.743-0.881) (p = 0.568) for the development and 0.954 (95% CI 0.896-1) (p = 0.097) for the temporal and external validation cohort. CONCLUSIONS The authors' scoring system is readily adoptable to predict the postoperative outcome for MMD. Their data revealed the importance of smoking and hyperlipidemia, which were the only modifiable factors included in the scoring system. The authors validated their scoring system both internally and externally and maintained good performance, highlighting the system's generalizability and reliability.
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Affiliation(s)
- Moinay Kim
- 1Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Wonhyoung Park
- 1Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Yeongu Chung
- 2Department of Neurosurgery, Kangbuk Samsung Medical Center Hospital, Seoul; and
| | - Si Un Lee
- 3Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung Cheol Park
- 1Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Do Hoon Kwon
- 1Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Jae Sung Ahn
- 1Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Seungjoo Lee
- 1Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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19
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Zheng S, Ge P, Li Y, Wang J, Shi Z, Zhang J, He L, Cheng L, Zhang D, He W. Association Between Ultrasound Parameters and History of Ischemic or Hemorrhagic Stroke in Patients With Moyamoya Disease. Front Neurol 2021; 12:570843. [PMID: 33658969 PMCID: PMC7917293 DOI: 10.3389/fneur.2021.570843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To explore the association between ultrasound parameters and previous ischemic or hemorrhagic stroke in patients with moyamoya disease (MMD), and develop an ultrasound-based nomogram to identify stroke in patients with MMD. Methods: We prospectively enrolled 52 consecutive patients (92 hemispheres) with MMD at the Beijing Tiantan Hospital. Thirty-six patients (65 hemispheres) were assigned to the training dataset from September 2019 to February 2020, and 16 patients (27 hemispheres) were assigned to the validation dataset from March 2020 to July 2020. Multivariate logistic regression analysis was applied to identify ultrasound parameters associated with previous history of ipsilateral stroke in patients with MMD, and a nomogram was subsequently constructed to identify stroke in patients with MMD. The performance of the nomogram was evaluated with respect to discrimination, calibration, and clinical usefulness. Results: Multivariate analysis indicated that the flow volume (FV) of the extracranial internal carotid artery (EICA) and the peak systolic velocity (PSV) of the posterior cerebral artery (PCA) were independently associated with ipsilateral stroke in patients with MMD, a nomogram incorporating these two parameters was constructed to identify stroke patients. The area under the receiver operating characteristic (AUROC) curves was 0.776 (95% CI, 0.656–0.870) in the training dataset and 0.753 (95% CI, 0.550–0.897) in the validation dataset suggested that the model had good discrimination ability. The calibration plot showed good agreement in both the two datasets. The decision curve analysis (DCA) revealed that the nomogram was clinically useful. Conclusions: Ultrasound parameters of EICA and PCA are independently associated with history of previous ipsilateral ischemic or hemorrhagic stroke in patients with MMD. The present ultrasound-based nomogram might provide information to identify MMD patients with high risk of stroke. Future long-term follow-up studies are needed to prove the predictive value in other independent cohorts. Clinical Trial Registration:http://www.chictr.org.cn/index.aspx. Unique Identifier: ChiCTR1900026075.
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Affiliation(s)
- Shuai Zheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peicong Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
| | - Yi Li
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jingzhe Wang
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhiyong Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
| | - Jinghan Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lei He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linggang Cheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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20
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Seiler A, Brandhofe A, Gracien RM, Pfeilschifter W, Hattingen E, Deichmann R, Nöth U, Wagner M. DSC perfusion-based collateral imaging and quantitative T2 mapping to assess regional recruitment of leptomeningeal collaterals and microstructural cortical tissue damage in unilateral steno-occlusive vasculopathy. J Cereb Blood Flow Metab 2021; 41:67-81. [PMID: 31987009 PMCID: PMC7747159 DOI: 10.1177/0271678x19898148] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Leptomeningeal collateral supply is considered pivotal in steno-occlusive vasculopathy to prevent chronic microstructural ischaemic tissue damage. The aim of this study was to assess the alleged protective role of leptomeningeal collaterals in patients with unilateral high-grade steno-occlusive vasculopathy using quantitative (q)T2 mapping and perfusion-weighted imaging (PWI)-based collateral abundance. High-resolution qT2 was used to estimate microstructural damage of the segmented normal-appearing cortex. Volumetric abundance of collaterals was assessed based on PWI source data. The ratio relative cerebral blood flow/relative cerebral blood volume (rCBF/rCBV) as a surrogate of relative cerebral perfusion pressure (rCPP) was used to investigate the intravascular hemodynamic competency of pial collateral vessels and the hemodynamic state of brain parenchyma. Within the dependent vascular territory with increased cortical qT2 values (P = 0.0001) compared to the contralateral side, parenchymal rCPP was decreased (P = 0.0001) and correlated negatively with increase of qT2 (P < 0.05). Furthermore, volumetric abundance of adjacent leptomeningeal collaterals was significantly increased (P < 0.01) and negatively correlated with changes of parenchymal rCPP (P = 0.01). Microstructural cortical damage is closely related to restrictions of antegrade blood flow despite increased pial collateral vessel abundance. Therefore, increased leptomeningeal collateral supply cannot necessarily be regarded as a sign of effective compensation in patients with high-grade steno-occlusive vasculopathy.
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Affiliation(s)
- Alexander Seiler
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
- Alexander Seiler, Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528 Frankfurt, Germany.
| | - Annemarie Brandhofe
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Elke Hattingen
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
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21
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Feghali J, Xu R, Yang W, Liew J, Tamargo RJ, Marsh EB, Huang J. Racial phenotypes in moyamoya disease: a comparative analysis of clinical presentation and natural history in a single multiethnic cohort of 250 hemispheres. J Neurosurg 2020; 133:1766-1772. [PMID: 31585430 DOI: 10.3171/2019.7.jns191507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors aimed to determine whether differences exist in presentation and natural history when comparing Asian patients with moyamoya disease (MMD) to those of other ethnicities in North America. METHODS A database of 137 patients with MMD presenting to their institution between 1994 and 2015 was reviewed. Baseline characteristics and outcome variables, including stroke and functional outcome, were compared between Asian and non-Asian patients. Unadjusted Kaplan-Meier survival analysis and adjusted Cox regression models were used to compare stroke-free survival and stroke hazard after diagnosis among hemispheres of both racial groups. The analysis was stratified by age group, and censoring was performed until last follow-up or at the time of surgery. Because the relative rate of stroke changed between Asian and non-Asian adults after 1.5 years of follow-up, a time-segmented analysis focusing on the period 1.5 years after diagnosis was performed. RESULTS The cohort comprised 23% (31/137) Asian and 77% (106/137) non-Asian patients with MMD with a bimodal age distribution. Non-Asian patients had a higher prevalence of increased BMI (p = 0.02) and smoking (p = 0.04). Among patients who presented with stroke (n = 90), hemorrhage was significantly more common among Asians (p = 0.02). The natural history analysis included 250 hemispheres: 67 pediatric and 183 adult hemispheres. The overall mean follow-up duration since diagnosis was 3.3 years. Among adults, Asian patients had a higher incidence of stroke (8.0 per 100 person-years vs 3.0 per 100 person-years) over a mean follow-up of 3.3 years, but results were not statistically significant (p = 0.45). In the period beginning 1.5 years after diagnosis, Asian adults had a significantly higher hazard of stroke over a mean follow-up of 7.7 years, while controlling for sex, hypertension, and stroke before diagnosis (hazard ratio 8.8, p = 0.02). Among pediatric patients, Asians also had a higher stroke incidence (10.0 per 100 person-years vs 3.5 per 100 person-years) over a mean follow-up of 3.2 years; however, results did not reach statistical significance (p = 0.40). Functional outcome was similar between both ethnic groups at last follow-up (p = 0.57). CONCLUSIONS This study suggests a comparatively more progressive course of MMD in Asians. Further studies are required to fully characterize the phenotypic distinctions between different races and underlying pathophysiological mechanisms.
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Affiliation(s)
| | | | | | | | | | - Elisabeth B Marsh
- 2Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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22
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Agarwal A, Bathla G, Kanekar S. Imaging of Non-atherosclerotic Vasculopathies. J Clin Imaging Sci 2020; 10:62. [PMID: 33194304 PMCID: PMC7656038 DOI: 10.25259/jcis_91_2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/12/2020] [Indexed: 11/09/2022] Open
Abstract
Non-atherosclerotic vasculopathies (NAVs) may present with various neurological symptoms ranging from headache, stroke, visual symptoms, and various types of intracranial hemorrhage. NAVs result from different etiologies which include collagenopathies, immunological, hematological, and infection mechanisms, and other rarer unidentifiable or idiopathic causes. NAV etiologies account for about 10–15% and 20–25% of adult and pediatric stroke cases, respectively, and therefore, diagnosing the underlying cause of NAV becomes clinically very important. Clinical diagnosis of NAV is challenging because the clinical presentation is very non-specific and overlapping with various other central nervous system disorders. Before the advent of non-invasive techniques, making a diagnosis of non-atherosclerotic vasculopathy as a cause of the stroke was very challenging. Today with newer techniques such as high-resolution magnetic resonance (MR), MR and computed tomography perfusion, and angiogram, there are number of pointers which can give us a lead about the non-atherosclerotic causes. Imaging may provide the first lead to the clinician regarding the diagnosis or possible differential diagnosis so that the targeted and focused biomarkers (blood, cerebrospinal fluid, or/and in some cases biopsies) may be obtained to clinch the diagnoses. The purpose of the article is to enumerate the causes, clinical features, and illustrate the imaging findings of the various non-atherosclerotic vasculopathic disorders and discuss “pearls” to their diagnosis. In this article, we have also discussed the latest advances in vascular imaging and elaborated on few uncommon non-atherosclerotic vasculopathies. These are very relevant clinically in the day-to-day practice for the radiologist, neurologist, and the neurointerventionalist.
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Affiliation(s)
- Amit Agarwal
- Department of Radiology, University Texas Southwestern, Dallas, Texas
| | - Girish Bathla
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Sangam Kanekar
- Department of Radiology, Penn State Health, Hershey, Pennsylvania, United States
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23
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Gao XY, Li Q, Li JR, Zhou Q, Qu JX, Yao ZW. A perfusion territory shift attributable solely to the secondary collaterals in moyamoya patients: a potential risk factor for preoperative hemorrhagic stroke revealed by t-ASL and 3D-TOF-MRA. J Neurosurg 2020; 133:780-788. [PMID: 31398708 DOI: 10.3171/2019.5.jns19803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors conducted a study to noninvasively and nonradioactively reveal moyamoya disease (MMD) intracerebral perfusion and perfusion territory supplied by the unilateral internal carotid artery (ICA) and external carotid artery (ECA) and bilateral vertebral arteries (VAs) before surgery and to further identify risk factors for preoperative hemorrhage in adult MMD. METHODS Forty-three consecutive adult patients with bilateral MMD underwent unenhanced T1-weighted MRI, territorial arterial spin labeling (t-ASL), and unenhanced 3D time-of-flight MRA (3D-TOF-MRA). Clinical factors, including age, sex, hypertension, diabetes mellitus, hyperlipidemia, current smoking status, and history of taking aspirin, were gathered and stratified. Univariate logistic regression analyses were used to examine the relationship between various risk factors and the occurrence of preoperative hemorrhage. Stepwise multivariate logistic regression analyses were used to determine independent risk factors of preoperative hemorrhage in MMD. RESULTS Among the 86 MMD hemispheres, t-ASL revealed 137 perfusion territory shifts in 79 hemispheres. Five distinct categories of perfusion territory shifts were observed on t-ASL maps. The subtypes of perfusion territory shift on t-ASL maps were further subdivided into 2 different categories, group A and group B, in combination with findings on 3D-TOF-MRA. A perfusion territory shift attributable solely to the secondary collaterals was a potential independent risk factor for preoperative hemorrhage (p = 0.026; 95% CI 1.201-18.615; OR 4.729). After eliminating the influence of the secondary collaterals, the primary collaterals had no significant effect on the risk of preoperative hemorrhage (p = 0.182). CONCLUSIONS t-ASL could reveal comprehensive MMD cerebral blood perfusion and the vivid perfusion territory shifts fed by the unilateral ICA and ECA and bilateral VAs in a noninvasive, straightforward, nonradioactive, and nonenhanced manner. 3D-TOF-MRA could subdivide t-ASL perfusion territory shifts according to their shunt arteries. A perfusion territory shift attributable to the secondary collaterals is a potential independent risk factor for preoperative hemorrhage in MMD patients. A perfusion territory shift fed by the primary collaterals may not have a strong effect on preoperative hemorrhage in MMD patients. These findings make the combined modalities of t-ASL and 3D-TOF-MRA a feasible tool for MMD disease assessment, management, and surgical strategy planning.
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Affiliation(s)
- Xin-Yi Gao
- 1Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province
| | - Qiao Li
- 2Department of Radiology, Shanghai Cancer Center, Fudan University
| | - Jing-Run Li
- 3Department of Neurosurgery, Huashan Hospital, Fudan University
| | - Qian Zhou
- 4Shanghai International Travel Medical Center
| | - Jian-Xun Qu
- 5Department of GE Healthcare China, MR Research China; and
| | - Zhen-Wei Yao
- 6Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
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24
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Cogswell PM, Lants SK, Davis LT, Juttukonda MR, Fusco MR, Donahue MJ. Vessel Wall and Lumen Features in North American Moyamoya Patients. Clin Neuroradiol 2020; 30:545-552. [PMID: 31388688 PMCID: PMC7245731 DOI: 10.1007/s00062-019-00819-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To apply intracranial vessel wall imaging (VWI) to determine changes in vessel wall characteristics between North American moyamoya patients and controls, as well as with standard clinical measures of moyamoya disease severity. METHODS North American moyamoya patients and controls underwent intracranial 3.0 T VWI. Moyamoya patients also underwent digital subtraction angiography (DSA), from which modified Suzuki scores (mSS) were calculated. Lumen and outer vessel wall diameters of the supraclinoid internal carotid arteries (ICAs) and basilar artery on VWI were measured by two readers from which wall thickness was calculated. Controls and moyamoya patients were compared in logistic regression using disease category (moyamoya or none) as the dependent variable and wall thickness, age, gender, and side as the explanatory variables (significance: two-sided p < 0.05). In moyamoya patients, regression was performed with mSS as the dependent variable and wall thickness, age, gender, and side as the explanatory variables. Analyses were repeated for each lumen diameter and outer vessel wall diameter in place of wall thickness. RESULTS Patients with moyamoya (n = 23, gender = 3/20 male/female; age = 43 ± 12 years) and controls (n = 23, gender = 3/20 male/female, age = 43 ± 13 years) were included. Moyamoya patients showed a significantly smaller ICA lumen and outer vessel wall diameter compared to controls (p < 0.05) but no significant change in vessel wall thickness. Similarly, ICA lumen and outer vessel wall diameters decreased with increasing mSS (p < 0.05). CONCLUSION Findings suggest decreased ICA lumen and outer vessel wall diameters, but no significant difference in wall thickness, between patients and controls. Lumen and outer vessel wall diameters also decreased with disease severity.
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Affiliation(s)
- Petrice M Cogswell
- Department of Radiology, Mayo Clinic, 200 First St SW, 55905, Rochester, MN, USA.
| | - Sarah K Lants
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L Taylor Davis
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Meher R Juttukonda
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew R Fusco
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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25
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Seiler A, Brandhofe A, Gracien RM, Pfeilschifter W, Hattingen E, Deichmann R, Nöth U, Wagner M. Microstructural Alterations Analogous to Accelerated Aging of the Cerebral Cortex in Carotid Occlusive Disease. Clin Neuroradiol 2020; 31:709-720. [PMID: 32638029 PMCID: PMC8463359 DOI: 10.1007/s00062-020-00928-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/10/2020] [Indexed: 11/28/2022]
Abstract
Purpose To investigate cortical thickness and cortical quantitative T2 values as imaging markers of microstructural tissue damage in patients with unilateral high-grade internal carotid artery occlusive disease (ICAOD). Methods A total of 22 patients with ≥70% stenosis (mean age 64.8 years) and 20 older healthy control subjects (mean age 70.8 years) underwent structural magnetic resonance imaging (MRI) and high-resolution quantitative (q)T2 mapping. Generalized linear mixed models (GLMM) controlling for age and white matter lesion volume were employed to investigate the effect of ICAOD on imaging parameters of cortical microstructural integrity in multivariate analyses. Results There was a significant main effect (p < 0.05) of the group (patients/controls) on both cortical thickness and cortical qT2 values with cortical thinning and increased cortical qT2 in patients compared to controls, irrespective of the hemisphere. The presence of upstream carotid stenosis had a significant main effect on cortical qT2 values (p = 0.01) leading to increased qT2 in the poststenotic hemisphere, which was not found for cortical thickness. The GLMM showed that in general cortical thickness was decreased and cortical qT2 values were increased with increasing age (p < 0.05). Conclusion Unilateral high-grade carotid occlusive disease is associated with widespread cortical thinning and prolongation of cortical qT2, presumably reflecting hypoperfusion-related microstructural cortical damage similar to accelerated aging of the cerebral cortex. Cortical thinning and increase of cortical qT2 seem to reflect different aspects and different pathophysiological states of cortical degeneration. Quantitative T2 mapping might be a sensitive imaging biomarker for early cortical microstructural damage.
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Affiliation(s)
- Alexander Seiler
- Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany. .,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany.
| | - Annemarie Brandhofe
- Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Waltraud Pfeilschifter
- Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
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26
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Hendrik Bas van Niftrik C, Sebök M, Muscas G, Piccirelli M, Serra C, Krayenbühl N, Pangalu A, Bozinov O, Luft A, Stippich C, Regli L, Fierstra J. Characterizing ipsilateral thalamic diaschisis in symptomatic cerebrovascular steno-occlusive patients. J Cereb Blood Flow Metab 2020; 40:563-573. [PMID: 30755133 PMCID: PMC7026850 DOI: 10.1177/0271678x19830532] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/03/2019] [Accepted: 01/15/2019] [Indexed: 11/17/2022]
Abstract
The clinical significance of ipsilateral thalamic diaschisis (ITD) occurring after stroke is unknown. To characterize ITD, we investigate its hemodynamic, structural, and clinical implications. A single-institution prospective cross-sectional study was conducted using 28 symptomatic cerebrovascular steno-occlusive patients undergoing both BOLD-CVR and Diamox-challenged 15(O)-H2O-PET. Follow-up was at least three months. In addition, 15 age-matched healthy subjects were included. ITD was diagnosed based on a BOLD-CVR thalamic asymmetry index (TAI) > +2 standard deviations from healthy subjects. Cerebral blood flow differences were assessed using a PET-based TAI before and after Diamox challenge. Thalamic volume masks were determined using Freesurfer. Neurological status at symptom onset and after three months was determined with NIHSS and mRS scores. ITD was diagnosed in 15 of 28 (57%) patients. PET-TAI before and after Diamox challenge were increased in patients with ITD, indicating an ipsilateral thalamic blood flow decrease. Patients with ITD exhibited a marked ipsilateral thalamic volume decrease as compared to patients without ITD and healthy subjects. Furthermore, patients with ITD had worse NIHSS and mRS at symptom onset and after three months follow-up, even after adjustment for stroke volume. The presence of ITD is characterized by thalamic volume reduction, reduced thalamic blood flow, and worse neurological performance unrelated to stroke volume.
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Affiliation(s)
- Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Giovanni Muscas
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- Department of Neurosurgery, Careggi University Hospital, Florence, University of Florence, Italy
| | - Marco Piccirelli
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Carlo Serra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Niklaus Krayenbühl
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Athina Pangalu
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Andreas Luft
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
| | - Christoph Stippich
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
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27
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Cerebral Revascularization Accelerates the Angiographic Staging Progression of the Operated Hemisphere in a Pediatric Patient With Moyamoya Disease. J Craniofac Surg 2019; 30:1180-1183. [PMID: 30896520 DOI: 10.1097/scs.0000000000005256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Angiographic staging progression in the operated hemisphere of patient with moyamoya disease (MMD) is a common phenomenon that neurosurgeons may encounter. However, few studies have been carried out to demonstrate the correlation between the operation and angiographic staging progression. This study aimed to reveal whether cerebral revascularization would affect the stage progression in patient with MMD. METHODS A total of 20 pediatric patients with bilateral MMD were included in this study. All enrolled patients were at the similar Suzuki angiographic staging on bilateral hemispheres and cerebral revascularization was performed in unilateral hemisphere. Angiographic examination was performed in the first year after the operation to evaluate the progression of the lesions. RESULTS Cerebral revascularizations including direct bypass or encephaloduroarteriosynangiosis were performed in 20 hemispheres. During the follow-up, the incidence of stage progression in the operated hemisphere was significantly higher than in the contralateral side (80.0% versus 20.0%, respectively; P = 0.036) and the interval of disease progression was significantly shorter in the operated side than in the contralateral side (mean interval time, 7.3 versus 10 months). Earlier Suzuki stage on hemisphere represented faster pace of stage progression compared with server Suzuki stage (OR = -0.612, P = 0.004), while neoformative collaterals had not significant correlation with the progression pace. The leptomeningeal collaterals from the posterior circulation decreased in almost all operated hemisphere, while gradually increasing in the contralateral hemisphere. Symptoms were improved in all patients after operation. CONCLUSION Cerebral revascularization would significantly accelerate the angiographic staging progression on the treated hemisphere, while it would not cause the deterioration of the patient's condition. The progression pace was associated with Suzuki stage.
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28
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Bersano A, Bedini G, Nava S, Acerbi F, Sebastiano DR, Binelli S, Franceschetti S, Faragò G, Grisoli M, Gioppo A, Ferroli P, Bruzzone MG, Riva D, Ciceri E, Pantaleoni C, Saletti V, Esposito S, Nardocci N, Zibordi F, Caputi L, Marzoli SB, Zedde ML, Pavanello M, Raso A, Capra V, Pantoni L, Sarti C, Pezzini A, Caria F, Dell' Acqua ML, Zini A, Baracchini C, Farina F, Sanguigni S, De Lodovici ML, Bono G, Capone F, Di Lazzaro V, Lanfranconi S, Toscano M, Di Piero V, Sacco S, Carolei A, Toni D, Paciaroni M, Caso V, Perrone P, Calloni MV, Romani A, Cenzato M, Fratianni A, Ciusani E, Prontera P, Lasserve ET, Blecharz K, Vajkoczy P, Parati EA. GEN-O-MA project: an Italian network studying clinical course and pathogenic pathways of moyamoya disease-study protocol and preliminary results. Neurol Sci 2019; 40:561-570. [PMID: 30604336 DOI: 10.1007/s10072-018-3664-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND GENetics of mOyaMoyA (GEN-O-MA) project is a multicenter observational study implemented in Italy aimed at creating a network of centers involved in moyamoya angiopathy (MA) care and research and at collecting a large series and bio-repository of MA patients, finally aimed at describing the disease phenotype and clinical course as well as at identifying biological or cellular markers for disease progression. The present paper resumes the most important study methodological issues and preliminary results. METHODS Nineteen centers are participating to the study. Patients with both bilateral and unilateral radiologically defined MA are included in the study. For each patient, detailed demographic and clinical as well as neuroimaging data are being collected. When available, biological samples (blood, DNA, CSF, middle cerebral artery samples) are being also collected for biological and cellular studies. RESULTS Ninety-eight patients (age of onset mean ± SD 35.5 ± 19.6 years; 68.4% females) have been collected so far. 65.3% of patients presented ischemic (50%) and haemorrhagic (15.3%) stroke. A higher female predominance concomitantly with a similar age of onset and clinical features to what was reported in previous studies on Western patients has been confirmed. CONCLUSION An accurate and detailed clinical and neuroimaging classification represents the best strategy to provide the characterization of the disease phenotype and clinical course. The collection of a large number of biological samples will permit the identification of biological markers and genetic factors associated with the disease susceptibility in Italy.
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Affiliation(s)
- Anna Bersano
- Cerebrovascular Unit, Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy.
| | - Gloria Bedini
- Laboratory of Cellular Neurobiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Nava
- Laboratory of Cellular Neurobiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Neurosurgical Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Davide Rossi Sebastiano
- Neurophysiopathology Department and Epilepsy Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Simona Binelli
- Neurophysiopathology Department and Epilepsy Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvana Franceschetti
- Neurophysiopathology Department and Epilepsy Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Faragò
- Diagnostic Imaging Department & Interventional Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marina Grisoli
- Neuroradiological Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Gioppo
- Diagnostic Imaging Department & Interventional Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Neurosurgical Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiological Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Daria Riva
- Developmental Neurology Division, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisa Ciceri
- Neuroradiological Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Pantaleoni
- Developmental Neurology Division, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Veronica Saletti
- Developmental Neurology Division, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvia Esposito
- Developmental Neurology Division, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nardo Nardocci
- Department of Child Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Federica Zibordi
- Department of Child Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luigi Caputi
- Cerebrovascular Unit, Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy
| | | | - Maria Luisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Valeria Capra
- Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Leonardo Pantoni
- L.Sacco Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Cristina Sarti
- NEUROFARBA Department Neuroscience Section, University of Florence, Florence, Italy
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Filomena Caria
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Maria Luisa Dell' Acqua
- Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Modena, Italy
| | - Andrea Zini
- Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Modena, Italy
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Department of Neurological Sciences, University of Padua School of Medicine, Padua, Italy
| | - Filippo Farina
- Stroke Unit and Neurosonology Laboratory, Department of Neurological Sciences, University of Padua School of Medicine, Padua, Italy
| | - Sandro Sanguigni
- Department of Neurology, General Hospital Madonna del Soccorso, San Benedetto del Tronto, Italy
| | | | - Giorgio Bono
- Stroke Unit Circolo Hospital and Macchi Foundation, Varese Hospital, Varese, Italy
| | - Fioravanti Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Silvia Lanfranconi
- Department of Neuroscience and Sensory Organs, Neurology Unit, Maggiore Policlinico Hospital Foundation IRCCS Ca' Granda, Milan, Italy
| | - Massimiliano Toscano
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Simona Sacco
- Department of Neurology, Avezzano Hospital, University of L'Aquila, L'Aquila, Italy
| | - Antonio Carolei
- Department of Neurology, Avezzano Hospital, University of L'Aquila, L'Aquila, Italy
| | - Danilo Toni
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Maurizio Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Valeria Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Patrizia Perrone
- Stroke Unit Legnano Hospital ASST Ovest Milanese, Legnano, Italy
| | | | - Alfredo Romani
- IRCCS Foundation C. Mondino Neurological Institute, Pavia, Italy
| | - Marco Cenzato
- Department of Neurosurgery, Niguarda Cà Granda Hospital, Milan, Italy
| | - Alessia Fratianni
- Department of Neurosurgery, Niguarda Cà Granda Hospital, Milan, Italy
| | - Emilio Ciusani
- Laboratory of Clinical Investigations, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Prontera
- Neonatology Unit and Prenatal Diagnosis (P.P.), Medical Genetic Unit, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Elisabeth Tournier Lasserve
- Inserm UMR-S1161, Génétique et Physiopathologie des Maladies Cérébro-vasculaires, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Kinga Blecharz
- Department of Neurosurgery, Charite Universitätsmedizin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charite Universitätsmedizin, Berlin, Germany
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29
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Santoro JD, Lee S, Mlynash M, Nguyen T, Lazzareschi DV, Kraler LD, Mayne EW, Steinberg GK. Blood Pressure Elevation and Risk of Moyamoya Syndrome in Patients With Trisomy 21. Pediatrics 2018; 142:peds.2018-0840. [PMID: 30190347 DOI: 10.1542/peds.2018-0840] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Individuals with Down syndrome (DS) are at risk for the development of moyamoya syndrome (MMS); MMS is often recognized only after a resulting stroke has occurred. Our goal with this study was to determine if elevations in blood pressure (BP) precede acute presentation of MMS in individuals with DS. METHODS A single-center, retrospective case-control study was performed. Thirty patients with MMS and DS and 116 patients with DS only were identified retrospectively. Three BP recordings were evaluated at set intervals (18-24 months, 12-18 months, and 6-12 months before diagnosis of MMS). These were then compared against control averages from patients with DS only. To assess changes over the time, we used general linear model repeated measures analysis of variance. To identify independent predictors of MMS and DS, we used a multivariable analysis using generalized estimating equations accounting for repeated measures of BP. RESULTS BP in patients with MMS and DS rose significantly over the 24-month period preceding presentation (34th, 42nd, and 70th percentiles at the 18-24-month, 12-18-month, and 6-12-month periods, respectively). BPs in the patients with both MMS and DS were significantly higher than in the DS-only controls in the 6 to 12 (P < .001) and 12 to 18 months before presentation (P = .016). Higher Suzuki scores, bilateral disease, and posterior circulation involvement were also predictive of BP elevation before presentation. CONCLUSIONS Elevations in BP may foreshadow presentation of MMS in individuals with DS. This simple, low-cost screening measure may lead to early identification of at-risk patients in the medical home and prevent irreversible neurologic injury.
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Affiliation(s)
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology.,Division of Stroke and Neurocritical Care, Department of Neurology.,Departments of Neurology and.,Neurosurgery
| | - Michael Mlynash
- Division of Stroke and Neurocritical Care, Department of Neurology
| | - Thuy Nguyen
- Division of Child Neurology, Department of Neurology
| | | | | | | | - Gary K Steinberg
- Division of Stroke and Neurocritical Care, Department of Neurology.,Departments of Neurology and.,Neurosurgery
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30
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Watchmaker JM, Juttukonda MR, Davis LT, Scott AO, Faraco CC, Gindville MC, Jordan LC, Cogswell PM, Jefferson AL, Kirshner HS, Donahue MJ. Hemodynamic mechanisms underlying elevated oxygen extraction fraction (OEF) in moyamoya and sickle cell anemia patients. J Cereb Blood Flow Metab 2018; 38:1618-1630. [PMID: 28029271 PMCID: PMC6125968 DOI: 10.1177/0271678x16682509] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Moyamoya is a bilateral, complex cerebrovascular condition characterized by progressive non-atherosclerotic intracranial stenosis and collateral vessel formation. Moyamoya treatment focuses on restoring cerebral blood flow (CBF) through surgical revascularization, however stratifying patients for revascularization requires abilities to quantify how well parenchyma is compensating for arterial steno-occlusion. Globally elevated oxygen extraction fraction (OEF) secondary to CBF reduction may serve as a biomarker for tissue health in moyamoya patients, as suggested in patients with sickle cell anemia (SCA) and reduced oxygen carrying capacity. Here, OEF was measured (TRUST-MRI) to test the hypothesis that OEF is globally elevated in patients with moyamoya (n = 18) and SCA (n = 18) relative to age-matched controls (n = 43). Mechanisms underlying the hypothesized OEF increases were evaluated by performing sequential CBF-weighted, cerebrovascular reactivity (CVR)-weighted, and structural MRI. Patients were stratified by treatment and non-parametric tests applied to compare study variables (significance: two-sided P < 0.05). OEF was significantly elevated in moyamoya participants (interquartile range = 0.38-0.45) compared to controls (interquartile range = 0.29-0.38), similar to participants with SCA (interquartile range = 0.37-0.45). CBF was inversely correlated with OEF in moyamoya participants. Elevated OEF was only weakly related to reductions in CVR, consistent with basal CBF level, rather than vascular reserve capacity, being most closely associated with OEF.
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Affiliation(s)
- Jennifer M Watchmaker
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Meher R Juttukonda
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Larry T Davis
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Allison O Scott
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Carlos C Faraco
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Melissa C Gindville
- 2 Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, USA
| | - Lori C Jordan
- 2 Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, USA
| | - Petrice M Cogswell
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Angela L Jefferson
- 3 Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, USA.,4 Department of Neurology, Vanderbilt University Medical Center, Nashville, USA
| | - Howard S Kirshner
- 4 Department of Neurology, Vanderbilt University Medical Center, Nashville, USA
| | - Manus J Donahue
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA.,4 Department of Neurology, Vanderbilt University Medical Center, Nashville, USA.,5 Department of Psychiatry, Vanderbilt University Medical Center, Nashville, USA
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31
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Donahue MJ, Achten E, Cogswell PM, De Leeuw FE, Derdeyn CP, Dijkhuizen RM, Fan AP, Ghaznawi R, Heit JJ, Ikram MA, Jezzard P, Jordan LC, Jouvent E, Knutsson L, Leigh R, Liebeskind DS, Lin W, Okell TW, Qureshi AI, Stagg CJ, van Osch MJP, van Zijl PCM, Watchmaker JM, Wintermark M, Wu O, Zaharchuk G, Zhou J, Hendrikse J. Consensus statement on current and emerging methods for the diagnosis and evaluation of cerebrovascular disease. J Cereb Blood Flow Metab 2018; 38:1391-1417. [PMID: 28816594 PMCID: PMC6125970 DOI: 10.1177/0271678x17721830] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/26/2017] [Accepted: 06/10/2017] [Indexed: 01/04/2023]
Abstract
Cerebrovascular disease (CVD) remains a leading cause of death and the leading cause of adult disability in most developed countries. This work summarizes state-of-the-art, and possible future, diagnostic and evaluation approaches in multiple stages of CVD, including (i) visualization of sub-clinical disease processes, (ii) acute stroke theranostics, and (iii) characterization of post-stroke recovery mechanisms. Underlying pathophysiology as it relates to large vessel steno-occlusive disease and the impact of this macrovascular disease on tissue-level viability, hemodynamics (cerebral blood flow, cerebral blood volume, and mean transit time), and metabolism (cerebral metabolic rate of oxygen consumption and pH) are also discussed in the context of emerging neuroimaging protocols with sensitivity to these factors. The overall purpose is to highlight advancements in stroke care and diagnostics and to provide a general overview of emerging research topics that have potential for reducing morbidity in multiple areas of CVD.
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Affiliation(s)
- Manus J Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physics and Astronomy, Vanderbilt University, Nashville, TN, USA
| | - Eric Achten
- Department of Radiology and Nuclear Medicine, Universiteit Gent, Gent, Belgium
| | - Petrice M Cogswell
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Frank-Erik De Leeuw
- Radboud University, Nijmegen Medical Center, Donders Institute Brain Cognition & Behaviour, Center for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | - Colin P Derdeyn
- Department of Radiology and Neurology, University of Iowa, Iowa City, IA, USA
| | - Rick M Dijkhuizen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Audrey P Fan
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Rashid Ghaznawi
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeremy J Heit
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University, CA, USA
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Peter Jezzard
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric Jouvent
- Department of Neurology, AP-HP, Lariboisière Hospital, Paris, France
| | - Linda Knutsson
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Richard Leigh
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | | | - Weili Lin
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas W Okell
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Adnan I Qureshi
- Department of Neurology, Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA
| | - Charlotte J Stagg
- Oxford Centre for Human Brain Activity, University of Oxford, Oxford, UK
| | | | - Peter CM van Zijl
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jennifer M Watchmaker
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Max Wintermark
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University, CA, USA
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Greg Zaharchuk
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University, CA, USA
| | - Jinyuan Zhou
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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32
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Matsushige T, Kraemer M, Sato T, Berlit P, Forsting M, Ladd ME, Jabbarli R, Sure U, Khan N, Schlamann M, Wrede KH. Visualization and Classification of Deeply Seated Collateral Networks in Moyamoya Angiopathy with 7T MRI. AJNR Am J Neuroradiol 2018; 39:1248-1254. [PMID: 29880473 DOI: 10.3174/ajnr.a5700] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 03/07/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Collateral networks in Moyamoya angiopathy have a complex angioarchitecture difficult to comprehend on conventional examinations. This study aimed to evaluate morphologic patterns and the delineation of deeply seated collateral networks using ultra-high-field MRA in comparison with conventional DSA. MATERIALS AND METHODS Fifteen white patients with Moyamoya angiopathy were investigated in this prospective trial. Sequences acquired at 7T were TOF-MRA with 0.22 × 0.22 × 0.41 mm3 resolution and MPRAGE with 0.7 × 0.7 × 0.7 mm3 resolution. Four raters evaluated the presence of deeply seated collateral networks and image quality in a consensus reading of DSA, TOF-MRA, and MPRAGE using a 5-point scale in axial source images and maximum intensity projections. Delineation of deeply seated collateral networks by different imaging modalities was compared by means of the McNemar test, whereas image quality was compared using the Wilcoxon signed-rank test. RESULTS The relevant deeply seated collateral networks were classified into 2 categories and 6 pathways. A total of 100 collateral networks were detected on DSA; 106, on TOF-MRA; and 73, on MPRAGE. Delineation of deeply seated collateral networks was comparable between TOF-MRA and DSA (P = .25); however, both were better than MPRAGE (P < .001). CONCLUSIONS This study demonstrates excellent delineation of 6 distinct deeply seated collateral network pathways in Moyamoya angiopathy in white adults using 7T TOF-MRA, comparable to DSA.
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Affiliation(s)
- T Matsushige
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Neurosurgery (T.M.), Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., T.S., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
| | - M Kraemer
- Department of Neurology (M.K., P.B.), Alfried Krupp Hospital, Essen, Germany.,Department of Neurology (M.K.), University Hospital Duesseldorf, Duesseldorf, Germany
| | - T Sato
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., T.S., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany.,Department of Neurosurgery (T.S.), Fukushima Medical University, Fukushima, Japan
| | - P Berlit
- Department of Neurology (M.K., P.B.), Alfried Krupp Hospital, Essen, Germany
| | - M Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology (M.F., M.S.), University Hospital Essen, Essen, Germany
| | - M E Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., T.S., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany.,Medical Physics in Radiology (M.E.L.), German Cancer Research Center, Heidelberg, Germany.,Faculty of Physics and Astronomy and Faculty of Medicine (M.E.L.), University of Heidelberg, Heidelberg, Germany
| | - R Jabbarli
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - U Sure
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - N Khan
- Moyamoya Center, Division of Pediatric Neurosurgery (N.K.), Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Schlamann
- Department of Diagnostic and Interventional Radiology and Neuroradiology (M.F., M.S.), University Hospital Essen, Essen, Germany.,Department of Neuroradiology (M.S.), University Hospital Cologne, Cologne, Germany
| | - K H Wrede
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany .,Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., T.S., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
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赵 庆, 王 刚, 肖 浩, 冯 文, 张 国, 李 明, 廖 永, 温 运, 漆 松. [Characteristics of collateral circulation in adult moyamoya disease based on modified Suzuki staging]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:483-489. [PMID: 29735452 PMCID: PMC6765649 DOI: 10.3969/j.issn.1673-4254.2018.04.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the characteristics of collateral circulation in adult moyamoya disease (MMD). METHODS The clinical data were collected from all adult patients with MMD undergoing digital subtractive angiography (DSA) in our department from 2006 to 2016. Based on the imaging findings, the patients were divided into ischemia group and bleeding group. A double-blind analysis was conducted of the CT or magnetic resonance imaging findings and the severity of the disease was graded using the modified Suzuki score (mSS). We classified the anastomotic networks in MMD into the superficial meningeal type and deep parenchymal type. The superficial meningeal type was further classified into the leptomeningeal and the durocortical networks, and the deep parenchymal networks into subependymal networks and the inner striatal and inner thalamic networks. RESULTS No significant difference was found in the distribution of mSS scores between the hemorrhage group and the ischemic group (Χ2=5.812, v=5, P=0.325), but the posterior communicating artery and internal carotid artery diameter ratio (Pcom/ICA ratio) was significantly greater in the hemorrhage group (t=2.119, v=108, P=0.036). The Pcom/ICA ratio differed significantly among the groups with different mSS scores (f=8.924, P=0.00), higher in groups with mSS scores of 3, 4 and 5. The incidence of anterior choroidal artery dilation differed significantly between hemorrhage and ischemic groups (Χ2=11.79, P=0.001). The incidences of durocortical networks (Χ2=0.327, P=0.567) and subependymal networks (Χ2=0.011, P=0.917) were comparable between hemorrhage group and ischemic groups, but the incidence of leptomeningeal networks (P=0.018) and inner striatal and inner thalamic networks (Χ2=7.551, P=0.006) differed significantly between the two groups. CONCLUSION The collateral circulation vascular system is an important component of cerebral blood flow in MMD patients and varies from patient to patient. Patients with MMD exhibit increased Pcom/ICA ratio with abnormal expansion of the anterior choroidal artery, and the leptomeningeal networks and the inner striatal and inner thalamic networks are independent risk factors for cerebral hemorrhage.
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Affiliation(s)
- 庆顺 赵
- />南方医科大学南方医院神经外科,广东 广州 510515Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 刚 王
- />南方医科大学南方医院神经外科,广东 广州 510515Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 浩江 肖
- />南方医科大学南方医院神经外科,广东 广州 510515Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 文峰 冯
- />南方医科大学南方医院神经外科,广东 广州 510515Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 国忠 张
- />南方医科大学南方医院神经外科,广东 广州 510515Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 明洲 李
- />南方医科大学南方医院神经外科,广东 广州 510515Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 永鸿 廖
- />南方医科大学南方医院神经外科,广东 广州 510515Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 运宇 温
- />南方医科大学南方医院神经外科,广东 广州 510515Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 松涛 漆
- />南方医科大学南方医院神经外科,广东 广州 510515Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Zhao M, Zhang D, Wang S, Zhang Y, Deng X, Zhao J. The Collateral Circulation in Moyamoya Disease: A Single-Center Experience in 140 Pediatric Patients. Pediatr Neurol 2017; 77:78-83. [PMID: 29107436 DOI: 10.1016/j.pediatrneurol.2017.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/17/2017] [Accepted: 08/20/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The patterns and clinical significance of the presence of collaterals in moyamoya disease has not been elucidated thoroughly. We aimed to summarize the clinical features of collaterals in pediatric moyamoya disease. BASIC PROCEDURES We reviewed consecutive pediatric patients with moyamoya vasculopathy who were admitted to our hospital from 2009 to 2015. Only pediatric moyamoya patients with digital subtraction angiography examinations were included in this study. We classified spontaneous collaterals into two groups by their origins, the internal carotid artery and vertebral artery (ICA-VA)-originated collaterals and the external carotid artery (ECA)-originated collaterals. MAIN FINDINGS A total of 140 pediatric patients with moyamoya disease (mean age, 10.1 ± 3.7 years) were included in this study. We identified collaterals originated from ICA-VA in 122 (87.1%) pediatric patients (222 hemispheres). Patients in the ICA-VA collaterals group had similar Suzuki stages with patients without collaterals originated from ICA-VA (mean, 3.86 vs 3.50; P = 0.157). We identified collaterals originated from ECAs in 70 (50.0%) pediatric patients (106 hemispheres) with moyamoya disease. The infarctions were more common in patients with ECA-originated collaterals than in patients without ECA-originated collaterals (25 versus 12; P = 0.021). PRINCIPAL CONCLUSIONS Our results demonstrate that collaterals originating from ECAs are associated with advanced Suzuki stages and infarction presentations in children with moyamoya disease.
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Affiliation(s)
- Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
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Tian B, Jiang Y, Kang Q, Xu B, Liu R, Liu Q, Lu J. Comparative study of 4D CTA and DSA for vascular assessment in moyamoya disease. Clin Imaging 2017; 48:74-78. [PMID: 29055274 DOI: 10.1016/j.clinimag.2017.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/18/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the vascular stenosis and collateral circulation in moyamoya disease using 4D CTA. METHODS Two neuroradiologists evaluated 4D CTA and DSA for 101 moyamoya patients. The performance of 4D CTA relative to DSA was determined using consistency checks (kappa values, 95% CI) and correlation analysis. RESULTS The kappa values were 0.714 (modified Suzuki score), 0.846 (Houkin score), 0.594 (basicranial moyamoya vessels), 0.435 (posterior circulation collaterals) and 0.591 (ECA collaterals). The correlation coefficients were 0.843, 0.872, 0.792, 0.635 and 0.797. CONCLUSIONS 4D CTA showed strong consistency and correlation with DSA in the vascular stenosis score, but was insufficient in collateral circulation evaluation.
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Affiliation(s)
- Bing Tian
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, China
| | - Yuanliang Jiang
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, China; Department of Radiology, Wuhan General Hospital of the People's Liberation Army, Wuhan, China
| | - Qinqin Kang
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, China
| | - Bing Xu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, China
| | - Ri Liu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, China
| | - Qi Liu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, China.
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Grading of moyamoya disease allows stratification for postoperative ischemia in bilateral revascularization surgery. Acta Neurochir (Wien) 2016; 158:1895-900. [PMID: 27573349 DOI: 10.1007/s00701-016-2941-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Moyamoya disease (MMD) may be graded based on DSA, the presence of ischemia in MRI and cerebrovascular reserve capacity allowing the prediction of ischemic symptoms in patients. Cerebral ischemia represents a severe complication in revascularization surgery. Focusing on different clinical features of hemodynamic impairment, MMD grading may allow prediction of ischemic complications. It was the aim to analyze whether MMD grading stratifies for ischemic complications in revascularization surgery for MMD. METHOD In 37 MMD patients a bilateral, standardized, one-staged revascularization approach consisting of STA-MCA bypass/encephalomyosynangiosis (EMS) and single EMS on the contralateral hemisphere was performed. Clinical data including DSA, MRI and rCBF (Xenon-CT) studies were assessed and used for grading MMD. All patients were observed on the ICU for at least 24 h and received CT imaging on the first postoperative day and in case of neurological deterioration. Ischemic complications were analyzed until the day of discharge and at 6-month follow-up. RESULTS Grading of MMD revealed 11 hemispheres (15 %) as grade I, 33 hemispheres (44 %) as grade II and 30 hemispheres (41 %) as grade III. Eight ischemic complications were observed (11 %). MMD grading demonstrated a significant correlation with ischemic complications: 0 complications in grade I, 3 in grade II (9 %) and 5 in grade III hemispheres (16 %; p < 0.05, Fisher's exact test). CONCLUSIONS The proposed grading system allows to stratify for ischemic complications in MMD patients that receive bilateral, one-staged revascularization surgery. Future studies will have to investigate its use for predicting ischemic complications in other revascularization strategies for MMD.
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Johns C, Kolla S, Hart A, Sinha S, Batty R, Connolly DJA. A pictorial review of imaging in paediatric stroke. Postgrad Med J 2016; 92:545-53. [PMID: 27354547 DOI: 10.1136/postgradmedj-2015-133409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/05/2016] [Indexed: 11/04/2022]
Abstract
Stroke is recognised as an important disease in adults. Paediatric stroke is less understood, yet still an important cause of morbidity and mortality, with an incidence of 5 per 100 000 children and is one of the top 10 leading causes of death in children. In adults the vast majority of strokes are ischaemic, whereas in children haemorrhage makes up half the cases. The incidence of neonatal stroke is much higher, at up to 45 per 100 000 population; however, the underlying causes are less understood. This paper acts as a guide to the different causes of stroke with the key differences on imaging discussed.
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Affiliation(s)
| | - S Kolla
- Radiology Department, Sheffield Teaching Hospitals, Sheffield, UK
| | - A Hart
- Neurology Department, Sheffield Children's Hospital, Sheffield, UK
| | - S Sinha
- Neurosurgery Department, Sheffield Children's Hospital, Sheffield, UK
| | - R Batty
- Radiology Department, Sheffield Teaching Hospitals, Sheffield, UK
| | - D J A Connolly
- Radiology Department, Sheffield Teaching Hospitals, Sheffield, UK
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Roach BA, Donahue MJ, Davis LT, Faraco CC, Arteaga D, Chen SC, Ladner TR, Scott AO, Strother MK. Interrogating the Functional Correlates of Collateralization in Patients with Intracranial Stenosis Using Multimodal Hemodynamic Imaging. AJNR Am J Neuroradiol 2016; 37:1132-8. [PMID: 27056428 DOI: 10.3174/ajnr.a4758] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/28/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE The importance of collateralization for maintaining adequate cerebral perfusion is increasingly recognized. However, measuring collateral flow noninvasively has proved elusive. The aim of this study was to assess correlations among baseline perfusion and arterial transit time artifacts, cerebrovascular reactivity, and the presence of collateral vessels on digital subtraction angiography. MATERIALS AND METHODS The relationship between the presence of collateral vessels on arterial spin-labeling MR imaging and DSA was compared with blood oxygen level-dependent MR imaging measures of hypercapnic cerebrovascular reactivity in patients with symptomatic intracranial stenosis (n = 18). DSA maps were reviewed by a neuroradiologist and assigned the following scores: 1, collaterals to the periphery of the ischemic site; 2, complete irrigation of the ischemic bed via collateral flow; and 3, normal antegrade flow. Arterial spin-labeling maps were scored according to the following: 0, low signal; 1, moderate signal with arterial transit artifacts; 2, high signal with arterial transit artifacts; and 3, normal signal. RESULTS In regions with normal-to-high signal on arterial spin-labeling, collateral vessel presence on DSA strongly correlated with declines in cerebrovascular reactivity (as measured on blood oxygen level-dependent MR imaging, P < .001), most notably in patients with nonatherosclerotic disease. There was a trend toward increasing cerebrovascular reactivity with increases in the degree of collateralization on DSA (P = .082). CONCLUSIONS Collateral vessels may have fundamentally different vasoreactivity properties from healthy vessels, a finding that is observed most prominently in nonatherosclerotic disease and, to a lesser extent, in atherosclerotic disease.
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Affiliation(s)
- B A Roach
- From the Departments of Radiology and Radiological Sciences (B.A.R., M.J.D., L.T.D., C.C.F., D.A., T.R.L., A.O.S., M.K.S.)
| | - M J Donahue
- From the Departments of Radiology and Radiological Sciences (B.A.R., M.J.D., L.T.D., C.C.F., D.A., T.R.L., A.O.S., M.K.S.) Neurology (M.J.D.) Psychiatry (M.J.D.)
| | - L T Davis
- From the Departments of Radiology and Radiological Sciences (B.A.R., M.J.D., L.T.D., C.C.F., D.A., T.R.L., A.O.S., M.K.S.)
| | - C C Faraco
- From the Departments of Radiology and Radiological Sciences (B.A.R., M.J.D., L.T.D., C.C.F., D.A., T.R.L., A.O.S., M.K.S.)
| | - D Arteaga
- From the Departments of Radiology and Radiological Sciences (B.A.R., M.J.D., L.T.D., C.C.F., D.A., T.R.L., A.O.S., M.K.S.)
| | - S-C Chen
- the Vanderbilt Center for Quantitative Sciences (S.-C.C.), Vanderbilt Medical Center, Nashville, Tennessee
| | - T R Ladner
- From the Departments of Radiology and Radiological Sciences (B.A.R., M.J.D., L.T.D., C.C.F., D.A., T.R.L., A.O.S., M.K.S.)
| | - A O Scott
- From the Departments of Radiology and Radiological Sciences (B.A.R., M.J.D., L.T.D., C.C.F., D.A., T.R.L., A.O.S., M.K.S.)
| | - M K Strother
- From the Departments of Radiology and Radiological Sciences (B.A.R., M.J.D., L.T.D., C.C.F., D.A., T.R.L., A.O.S., M.K.S.)
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Ladner TR, Donahue MJ, Arteaga DF, Faraco CC, Roach BA, Davis LT, Jordan LC, Froehler MT, Strother MK. Prior Infarcts, Reactivity, and Angiography in Moyamoya Disease (PIRAMD): a scoring system for moyamoya severity based on multimodal hemodynamic imaging. J Neurosurg 2016; 126:495-503. [PMID: 26967789 DOI: 10.3171/2015.11.jns15562] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Quantification of the severity of vasculopathy and its impact on parenchymal hemodynamics is a necessary prerequisite for informing management decisions and evaluating intervention response in patients with moyamoya. The authors performed digital subtraction angiography and noninvasive structural and hemodynamic MRI, and they outline a new classification system for patients with moyamoya that they have named Prior Infarcts, Reactivity, and Angiography in Moyamoya Disease (PIRAMD). METHODS Healthy control volunteers (n = 11; age 46 ± 12 years [mean ± SD]) and patients (n = 25; 42 ± 13.5 years) with angiographically confirmed moyamoya provided informed consent and underwent structural (T1-weighted, T2-weighted, FLAIR, MR angiography) and hemodynamic (T2*- and cerebral blood flow-weighted) 3-T MRI. Cerebrovascular reactivity (CVR) in the internal carotid artery territory was assessed using susceptibility-weighted MRI during a hypercapnic stimulus. Only hemispheres without prior revascularization were assessed. Each hemisphere was considered symptomatic if localizing signs were present on neurological examination and/or there was a history of transient ischemic attack with symptoms referable to that hemisphere. The PIRAMD factor weighting versus symptomatology was optimized using binary logistic regression and receiver operating characteristic curve analysis with bootstrapping. The PIRAMD finding was scored from 0 to 10. For each hemisphere, 1 point was assigned for prior infarct, 3 points for reduced CVR, 3 points for a modified Suzuki Score ≥ Grade II, and 3 points for flow impairment in ≥ 2 of 7 predefined vascular territories. Hemispheres were divided into 3 severity grades based on total PIRAMD score, as follows: Grade 1, 0-5 points; Grade 2, 6-9 points; and Grade 3, 10 points. RESULTS In 28 of 46 (60.9%) hemispheres the findings met clinical symptomatic criteria. With decreased CVR, the odds ratio of having a symptomatic hemisphere was 13 (95% CI 1.1-22.6, p = 0.002). The area under the curve for individual PIRAMD factors was 0.67-0.72, and for the PIRAMD grade it was 0.845. There were 0/8 (0%), 10/18 (55.6%), and 18/20 (90%) symptomatic PIRAMD Grade 1, 2, and 3 hemispheres, respectively. CONCLUSIONS A scoring system for total impairment is proposed that uses noninvasive MRI parameters. This scoring system correlates with symptomatology and may provide a measure of hemodynamic severity in moyamoya, which could be used for guiding management decisions and evaluating intervention response.
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Affiliation(s)
| | | | | | | | | | | | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics; and
| | - Michael T Froehler
- Departments of Neurology and Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Clinical and Angiographic Features of Patients with Moyamoya Disease and the p.R4810K Heterozygous Variant. World Neurosurg 2016; 90:530-538.e3. [PMID: 26806063 DOI: 10.1016/j.wneu.2015.12.093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/28/2015] [Accepted: 12/29/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To elucidate the clinical and angiographic features in patients with moyamoya disease (MMD) and the p.R4810K heterozygous variant and present an angiographic grading system to evaluate disease severity. METHODS We retrospectively reviewed 87 patients with MMD and the p.R4810K variant treated at Beijing Tiantan Hospital. Clinical features, stroke subtype, and angiographic characteristics were analyzed. RESULTS The median age at diagnosis was 25 years (range, 3-59). The ratio of women to men was 1.2:1. The familial occurrence of MMD was 14.9%. The primary symptom at diagnosis was ischemia, hemorrhage, or other in 67, 16, and 4 patients, respectively. Angiographic features correlating with ischemic stroke or stroke, including Suzuki grade, external carotid artery collaterals, leptomeningeal collaterals, and Mugikura grade, were identified. A binary logistic regression model demonstrated a significant correlation of Suzuki grade (P = 0.008) and posterior cerebral artery grade (P = 0.029) with ischemic stroke (142 hemispheres). A modified Suzuki-Mugikura grading system was developed. The areas under the receiver operating characteristic curves used to predict ischemic stroke based on the Suzuki grading, Mugikura grading, and modified Suzuki-Mugikura grading systems were 0.736, 0.69, and 0.741, respectively. Furthermore, the modified Suzuki-Mugikura grades were significantly correlated with infarction in posterior circulation and the number of infarcted regions. CONCLUSIONS The clinical and angiographic features of a Chinese MMD population with the p.R4810K variant were similar to those of a Japanese MMD population; they might be a distinct cerebrovascular disease entity and represent a separate subgroup. A modified Suzuki-Mugikura grading system was valuable for predicting stroke and evaluating disease severity.
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Ren B, Zhang ZS, Liu WW, Bao XY, Li DS, Han C, Xian P, Zhao F, Wang H, Wang H, Duan L. Surgical outcomes following encephaloduroarteriosynangiosis in adult moyamoya disease associated with Type 2 diabetes. J Neurosurg 2016; 125:308-14. [PMID: 26745491 DOI: 10.3171/2015.7.jns15218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Debate exists regarding the merits and shortcomings of an indirect bypass procedure for treating adult patients with moyamoya disease (MMD). Considerable variation in neovascularization occurs among different organs in patients with diabetes mellitus. Here, the effect of encephaloduroarteriosynangiosis on MMD associated with Type 2 diabetes mellitus (T2DM) is evaluated. METHODS A retrospective and 1:2 matched case-control study was conducted in moyamoya patients with or without T2DM (n = 180). Postoperative collateral formations were graded according to the Modified Collateral Grading System that originated from the Matsushima Angiographic Stage Classification. Neurological function outcomes before and after the operation were evaluated according to the modified Rankin Scale. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for clinical outcome. RESULTS There was no statistically significant difference in the constituent ratios of initial symptom and preoperative Suzuki stage between patients with and without T2DM. Progression of angiopathy around the circle of Willis was postoperatively observed in bilateral internal carotid arteries in both groups. Patients with T2DM had a higher postoperative Suzuki stage (p < 0.01) and more frequent development of collateral angiogenesis germinating from the external carotid after indirect revascularization procedures in the surgical cerebral hemisphere (82.7% vs 72.2%; p < 0.05). The extent of postoperative collateral formation in patients with diabetes mellitus was significantly higher (p < 0.01). Postoperative clinical improvement in the diabetes group was more common after revascularization procedures (p < 0.05), and the diabetes group had lower modified Rankin Scale scores (p < 0.05) in comparison with the nondiabetes group. Late postoperative stroke and posterior cerebral artery involvement were identified as predictors of unfavorable clinical outcome in both groups, while T2DM was associated with a favorable clinical outcome. CONCLUSIONS Encephaloduroarteriosynangiosis is an efficacious treatment for adult patients with MMD. Patients with T2DM could achieve better collateral circulation and clinical improvement following surgery.
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Affiliation(s)
- Bin Ren
- Cardiovascular Drug Research Center, Institute of Health and Environmental Medicine, Academy of Military Medical Sciences; and.,Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and
| | - Zheng-Shan Zhang
- Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and
| | - Wei-Wei Liu
- Consulting Centre of Biomedical Statistics, Academy of Military Medical Sciences, Beijing, China
| | - Xiang-Yang Bao
- Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and
| | - De-Sheng Li
- Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and
| | - Cong Han
- Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and
| | - Peng Xian
- Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and
| | - Feng Zhao
- Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and
| | - Hui Wang
- Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and
| | - Hai Wang
- Cardiovascular Drug Research Center, Institute of Health and Environmental Medicine, Academy of Military Medical Sciences; and
| | - Lian Duan
- Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and
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