Clinical significance of posterior circulation changes after revascularization in patients with Moyamoya disease

Abel Po Hao Huang, Hon Man Liu, Dar Ming Lai, Chi Cheng Yang, Yi Hsin Tsai, Kuo Chuan Wang, Shih Hung Yang, Meng Fai Kuo, Yong Kwang Tu

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objective: It has been noted that the posterior circulation serves as an important source of collateral blood supply in moyamoya disease. Since most of the literature has focused on non-operative cases and many symptomatic patients receive surgical revascularization, we evaluated the posterior circulation changes after revascularization and found that progressive posterior cerebral artery (PCA) steno-occlusive changes after revascularization caused cerebral hemodynamic compromise and clinical deterioration in a significant portion of patients. Methods: Twenty-three moyamoya disease patients with ischemic presentation who received revascularization with complete angiography and xenon CT during a minimum of 3 years' clinical follow-up were enrolled. Revascularization was performed in 38 hemispheres. Pre- and postoperative angiography were reviewed to determine the internal carotid artery (ICA) stage, PCA stage, leptomeningeal collateral (LMC) grade, and Matsushima synangiosis grade. The postoperative regional cerebral blood flow (CBF) and cerebral vascular reserve (CVR) were recorded and correlated with angiographic findings and clinical outcome. Results: Progression of ICA staging was noted in 23 sides (55.2%), and progression of PCA staging was noted in 18 sides (47.4%). Among the 18 cases of PCA stage progression, an associated decrease in LMC grade was noted in 12 sides (66.7%). These changes were associated with decreased regional CBF and CVR, which also explained the recurrent ischemic symptoms in 27.8% of these patients. In contrast, LMC grade increased in 15 (65.2%) sides of patients with ICA progression. Conclusions: Progressive steno-occlusive change in the PCA after revascularization is associated with a reduction in LMC blood flow and cerebral ischemia in moyamoya patients. This phenomenon might cause recurrent ischemic symptoms in 27.8% of patients.

Original languageEnglish
Pages (from-to)247-257
Number of pages11
JournalCerebrovascular Diseases
Volume28
Issue number3
DOIs
Publication statusPublished - Aug 1 2009
Externally publishedYes

Fingerprint

Moyamoya Disease
Posterior Cerebral Artery
Cerebrovascular Circulation
Internal Carotid Artery
Regional Blood Flow
Blood Vessels
Cerebral Revascularization
Xenon
Brain Ischemia
Angiography
Hemodynamics

Keywords

  • Angiography
  • Bypass surgery
  • Computed tomography
  • Moyamoya disease
  • Perfusion

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Clinical significance of posterior circulation changes after revascularization in patients with Moyamoya disease. / Huang, Abel Po Hao; Liu, Hon Man; Lai, Dar Ming; Yang, Chi Cheng; Tsai, Yi Hsin; Wang, Kuo Chuan; Yang, Shih Hung; Kuo, Meng Fai; Tu, Yong Kwang.

In: Cerebrovascular Diseases, Vol. 28, No. 3, 01.08.2009, p. 247-257.

Research output: Contribution to journalArticle

Huang, APH, Liu, HM, Lai, DM, Yang, CC, Tsai, YH, Wang, KC, Yang, SH, Kuo, MF & Tu, YK 2009, 'Clinical significance of posterior circulation changes after revascularization in patients with Moyamoya disease', Cerebrovascular Diseases, vol. 28, no. 3, pp. 247-257. https://doi.org/10.1159/000228254
Huang, Abel Po Hao ; Liu, Hon Man ; Lai, Dar Ming ; Yang, Chi Cheng ; Tsai, Yi Hsin ; Wang, Kuo Chuan ; Yang, Shih Hung ; Kuo, Meng Fai ; Tu, Yong Kwang. / Clinical significance of posterior circulation changes after revascularization in patients with Moyamoya disease. In: Cerebrovascular Diseases. 2009 ; Vol. 28, No. 3. pp. 247-257.
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AU - Huang, Abel Po Hao

AU - Liu, Hon Man

AU - Lai, Dar Ming

AU - Yang, Chi Cheng

AU - Tsai, Yi Hsin

AU - Wang, Kuo Chuan

AU - Yang, Shih Hung

AU - Kuo, Meng Fai

AU - Tu, Yong Kwang

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N2 - Objective: It has been noted that the posterior circulation serves as an important source of collateral blood supply in moyamoya disease. Since most of the literature has focused on non-operative cases and many symptomatic patients receive surgical revascularization, we evaluated the posterior circulation changes after revascularization and found that progressive posterior cerebral artery (PCA) steno-occlusive changes after revascularization caused cerebral hemodynamic compromise and clinical deterioration in a significant portion of patients. Methods: Twenty-three moyamoya disease patients with ischemic presentation who received revascularization with complete angiography and xenon CT during a minimum of 3 years' clinical follow-up were enrolled. Revascularization was performed in 38 hemispheres. Pre- and postoperative angiography were reviewed to determine the internal carotid artery (ICA) stage, PCA stage, leptomeningeal collateral (LMC) grade, and Matsushima synangiosis grade. The postoperative regional cerebral blood flow (CBF) and cerebral vascular reserve (CVR) were recorded and correlated with angiographic findings and clinical outcome. Results: Progression of ICA staging was noted in 23 sides (55.2%), and progression of PCA staging was noted in 18 sides (47.4%). Among the 18 cases of PCA stage progression, an associated decrease in LMC grade was noted in 12 sides (66.7%). These changes were associated with decreased regional CBF and CVR, which also explained the recurrent ischemic symptoms in 27.8% of these patients. In contrast, LMC grade increased in 15 (65.2%) sides of patients with ICA progression. Conclusions: Progressive steno-occlusive change in the PCA after revascularization is associated with a reduction in LMC blood flow and cerebral ischemia in moyamoya patients. This phenomenon might cause recurrent ischemic symptoms in 27.8% of patients.

AB - Objective: It has been noted that the posterior circulation serves as an important source of collateral blood supply in moyamoya disease. Since most of the literature has focused on non-operative cases and many symptomatic patients receive surgical revascularization, we evaluated the posterior circulation changes after revascularization and found that progressive posterior cerebral artery (PCA) steno-occlusive changes after revascularization caused cerebral hemodynamic compromise and clinical deterioration in a significant portion of patients. Methods: Twenty-three moyamoya disease patients with ischemic presentation who received revascularization with complete angiography and xenon CT during a minimum of 3 years' clinical follow-up were enrolled. Revascularization was performed in 38 hemispheres. Pre- and postoperative angiography were reviewed to determine the internal carotid artery (ICA) stage, PCA stage, leptomeningeal collateral (LMC) grade, and Matsushima synangiosis grade. The postoperative regional cerebral blood flow (CBF) and cerebral vascular reserve (CVR) were recorded and correlated with angiographic findings and clinical outcome. Results: Progression of ICA staging was noted in 23 sides (55.2%), and progression of PCA staging was noted in 18 sides (47.4%). Among the 18 cases of PCA stage progression, an associated decrease in LMC grade was noted in 12 sides (66.7%). These changes were associated with decreased regional CBF and CVR, which also explained the recurrent ischemic symptoms in 27.8% of these patients. In contrast, LMC grade increased in 15 (65.2%) sides of patients with ICA progression. Conclusions: Progressive steno-occlusive change in the PCA after revascularization is associated with a reduction in LMC blood flow and cerebral ischemia in moyamoya patients. This phenomenon might cause recurrent ischemic symptoms in 27.8% of patients.

KW - Angiography

KW - Bypass surgery

KW - Computed tomography

KW - Moyamoya disease

KW - Perfusion

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