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

研究成果: 雜誌貢獻文章同行評審

43 引文 斯高帕斯(Scopus)

摘要

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.
原文英語
頁(從 - 到)247-257
頁數11
期刊Cerebrovascular Diseases
28
發行號3
DOIs
出版狀態已發佈 - 八月 1 2009
對外發佈

ASJC Scopus subject areas

  • 神經內科
  • 神經病學(臨床)
  • 心臟病學與心血管醫學

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