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Multicenter Study
. 2014 Jun;35(6):1124-31.
doi: 10.3174/ajnr.A3819. Epub 2014 Jan 2.

Clinical and angiographic features and stroke types in adult moyamoya disease

D-K Jang  1 , K-S Lee  2 , H K Rha  3 , P-W Huh  4 , J-H Yang  5 , I S Park  6 , J-G Ahn  7 , J H Sung  8 , Y-M Han  1
Affiliations
Multicenter Study

Clinical and angiographic features and stroke types in adult moyamoya disease

D-K Jang et al. AJNR Am J Neuroradiol. 2014 Jun.

Abstract

Background and purpose: This study was conducted to elucidate the association between clinical and angiographic characteristics and stroke types in adult Moyamoya disease that has been rarely evaluated.

Materials and methods: We analyzed the clinical and radiologic data obtained from a retrospective adult Moyamoya disease cohort with acute strokes, which were classified into 7 categories: large-artery infarct, hemodynamic infarct, perforator infarct, deep intracerebral hemorrhage, lobar intracerebral hemorrhage, intraventricular hemorrhage, and SAH. With conventional angiography, which was performed in the hemispheres with acute strokes, the Suzuki angiographic stage, intracranial aneurysm, major artery occlusion, and collateral vessel development were confirmed within 1 month of stroke onset.

Results: This study included 79 patients with acute ischemic stroke and 96 patients with acute hemorrhagic stroke. The angiographic stage had a strong tendency to be more advanced in the hemorrhagic than the ischemic patients (P = .061). Intracranial aneurysms were more frequently found in the hemorrhagic than ischemic or control hemispheres (P = .002). Occlusions of the anterior cerebral artery and development of fetal-type posterior cerebral artery were more frequently observed in the hemorrhagic than the ischemic (P = .001 and .01, respectively) or control hemispheres (P = .011 and .013, respectively). MCA occlusion (P = .039) and collateral flow development, including the ethmoidal Moyamoya vessels (P = .036) and transdural anastomosis of the external carotid artery (P = .022), occurred more often in the hemorrhagic than the ischemic hemispheres. Anterior cerebral artery occlusion occurred more frequently in patients with deep intracerebral hemorrhage or intraventricular hemorrhage than with lobar intracerebral hemorrhage (P = .009).

Conclusions: In adult Moyamoya disease, major artery occlusion and collateral compensation occurred more often in the hemorrhagic than in the ischemic hemispheres. Thus, anterior cerebral artery occlusion with or without MCA occlusion and intracranial aneurysms may be the main contributing factors to hemorrhagic stroke in adult patients with Moyamoya disease.

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Figures

Fig 1.
Fig 1.
Representative radiologic and angiographic features of adult Moyamoya disease with ischemic (A–E) and hemorrhagic (F–J) stroke. Ischemic MMD shows right frontal large-artery infarct (A) with MCA occlusion (B) but without anterior cerebral artery occlusion (C) and good collateral flows from both posterior cerebral arteries (D) but without transdural anastomosis from the right external carotid artery (E). Hemorrhagic MMD shows left intraventricular hemorrhage (F), with ACA, MCA and PCA occlusion (G–I), with lenticulostriate artery aneurysm (G and H, white arrows) and the development of ethmoidal Moyamoya vessels (H), fetal-type PCA (H), and transdural anastomosis from the ECA (J, black arrow).
Fig 2.
Fig 2.
Topographic patterns of acute stroke (A), age distribution of adult Moyamoya disease according to stroke type (B, P = .28), and angiographic distribution of stroke type (C).
Fig 3.
Fig 3.
Angiographic patterns according to acute stroke type of 314 hemispheres in 175 adult patients with Moyamoya disease. Asterisks indicate statistical significances between the respective hemispheres (A–C, E, F, and I).
See this image and copyright information in PMC

References

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