Cortical Distribution of Fragile Periventricular Anastomotic Collateral Vessels in Moyamoya Disease: An Exploratory Cross-Sectional Study of Japanese Patients with Moyamoya Disease

Miyakoshi, Akinori; Funaki, Takeshi; Fushimi, Yasutaka; Nakae, Takuro; Okawa, Masakazu; Kikuchi, Takayuki; Kataoka, Hiroharu; Yoshida, Kazumichi; Mineharu, Yohei; Matsuhashi, Masao; Nakatani, Eiji; Miyamoto, Susumu

doi:10.3174/ajnr.a6861

Cited by 14 publications

(8 citation statements)

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“…We are aware of some limitations of our study which make it difficult to draw generalized conclusions. One limitation is the heterogeneity of grading systems, making comparisons difficult, for example, for collaterals in addition to the traditional pathways utilized here [ 12 , 38 ], as numerous other classification systems exist [ 23 , 26 , 39 – 41 ]. Another limitation is that this study is a single-center study with predominantly German patients, which also hinders generalization.…”

Section: Discussionmentioning

confidence: 99%

The angiographic presentation of European Moyamoya angiopathy

2021

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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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Section: Discussionmentioning

confidence: 99%

The angiographic presentation of European Moyamoya angiopathy

2021

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“…Choroidal anastomosis outflows to the cortex posterior to the CS, whereas lenticulostriate anastomosis outflows anterior to the CS. 16 Because a revascularization overlapping the outflow is more likely to normalize the medullary artery flow and promote successful reduction of the anastomosis, 6,31 a larger revascularization area posterior to the CS might increase the probability of the reduction of choroidal anastomosis.…”

Section: Discussionmentioning

confidence: 99%

“…We identified, however, some hemispheres exhibiting reduction of choroidal anastomosis despite relatively small posterior revascularization. This finding might be explained by 2 possible reasons: First, some of the choroidal anastomoses might outflow exactly into the CS 16 ; in such cases, the revascularization could overlap the outflow even with a limited revascularization area posterior to the CS. Second, augmentation of CBF in the cortex posterior to the CS, which could not be assessed with angiography alone, might account for the reduction of choroidal anastomosis.…”

Section: Discussionmentioning

confidence: 99%

“…15 A recent study revealed that choroidal anastomosis outflows to the cortex posterior to the central sulcus (CS). 16 We hypothesized that a larger angiographic extent of revascularization posterior to the CS is associated with the reduction of choroidal anastomosis. Testing this hypothesis might help to determine the optimal revascularization site for preventing hemorrhage.…”

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confidence: 99%

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Larger Posterior Revascularization Associated with Reduction of Choroidal Anastomosis in Moyamoya Disease: A Quantitative Angiographic Analysis

Funaki¹,

Miyakoshi²,

Kataoka

et al. 2022

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Choroidal anastomosis, a hemorrhage-prone periventricular collateral manifestation in Moyamoya disease, outflows to the cortex posterior to the central sulcus. The objective of the present study was to test whether the angiographic extent of revascularization posterior to the central sulcus contributes to the postoperative reduction of choroidal anastomosis. MATERIALS AND METHODS:This retrospective cohort study included choroidal anastomosis-positive hemispheres before direct bypass surgery. The postoperative reduction of choroidal anastomosis was determined by a consensus of 2 raters according to the previous research. An imaging software automatically traced the angiographic revascularization area, which was subsequently divided into anterior and posterior parts by an anatomic line corresponding to the central sulcus. Each area was quantitatively measured as a percentage relative to the whole supratentorial area. RESULTS:Postoperative reduction of choroidal anastomosis was achieved in 68 (85.0%) of the 80 included hemispheres. The revascularization area posterior to the central sulcus was significantly larger in the hemispheres with reduction than in those with no reduction (mean, 15.2% [SD, 7.1%] versus 4.2% [SD, 3.4%], P , .001), whereas no significant difference was observed in the revascularization area anterior to the central sulcus. Multivariate analysis revealed that the revascularization area posterior to the central sulcus was the only significant factor associated with reduction (OR, 1.57; 95% CI, 1.21-2.03, for every 1% increase). CONCLUSIONS:The results suggest that a larger revascularization posterior to the central sulcus is associated with postoperative reduction of choroidal anastomosis regardless of the extent of anterior revascularization. It might facilitate optimal selection of the revascularization site for preventing hemorrhage.ABBREVIATIONS: CS ¼ central sulcus; PCA ¼ posterior cerebral artery; STA ¼ superficial temporal artery C horoidal anastomosis is one of the abnormal periventricular collaterals in Moyamoya disease. [1][2][3][4][5] The collateral is characterized by a connection between the choroidal and medullary arteries, which outflows to the cortex via retrograde flow in the medullary artery (Fig 1). 2,3,6 Choroidal anastomosis is commonly observed in hemorrhagic Moyamoya disease [7][8][9] and is associated with an extremely high risk of bleeding. 4,5,10 After bypass surgery, the normalized direction of flow in the medullary artery can induce angiographic reduction of choroidal anastomosis. 6,11 This change might explain the effectiveness of direct bypass in preventing bleeding. 12-14 However, only a few studies have focused on the factors contributing to this change. 15 A recent study revealed that choroidal anastomosis outflows to the cortex posterior to the central sulcus (CS). 16 We hypothesized that a larger angiographic extent of revascularization posterior to the CS is associated with the reduction of choroidal anastomosis. Testing this hypothesis m...

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“…Megamonas funiformis 95%CI 95% confidence interval Moyamoya disease (MMD) is a progressive vasculopathy characterized by occlusive lesions in the terminal portion of the internal carotid arteries, which often causes ischemic complications [1][2][3] . Abnormal vascular networks called moyamoya vessels and periventricular anastomosis develops as collaterals, and fragile periventricular anastomoses, which create retrograde blood flow in the medullary arteries, are prone to bleed 4,5 .…”

Section: Ratti Veillonella Ratti I Bartlettii Intestinibacter Bartlet...mentioning

confidence: 99%

Increased abundance of Ruminococcus gnavus in gut microbiota is associated with moyamoya disease and non-moyamoya intracranial large artery disease

Mineharu

Nakamura

Sato

et al. 2022

Sci Rep

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Moyamoya disease (MMD) is a rare cerebrovascular disease endemic in East Asia. The p.R4810K mutation in RNF213 gene confers a risk of MMD, but other factors remain largely unknown. We tested the association of gut microbiota with MMD. Fecal samples were collected from 27 patients with MMD, 7 patients with non-moyamoya intracranial large artery disease (ICAD) and 15 control individuals with other disorders, and 16S rRNA were sequenced. Although there was no difference in alpha diversity or beta diversity between patients with MMD and controls, the cladogram showed Streptococcaceae was enriched in patient samples. The relative abundance analysis demonstrated that 23 species were differentially abundant between patients with MMD and controls. Among them, increased abundance of Ruminococcus gnavus > 0.003 and decreased abundance of Roseburia inulinivorans < 0.002 were associated with higher risks of MMD (odds ratio 9.6, P = 0.0024; odds ratio 11.1, P = 0.0051). Also, Ruminococcus gnavus was more abundant and Roseburia inulinivorans was less abundant in patients with ICAD than controls (P = 0.046, P = 0.012). The relative abundance of Ruminococcus gnavus or Roseburia inulinivorans was not different between the p.R4810K mutant and wildtype. Our data demonstrated that gut microbiota was associated with both MMD and ICAD.

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Cortical Distribution of Fragile Periventricular Anastomotic Collateral Vessels in Moyamoya Disease: An Exploratory Cross-Sectional Study of Japanese Patients with Moyamoya Disease

Cited by 14 publications

References 30 publications

The angiographic presentation of European Moyamoya angiopathy

The angiographic presentation of European Moyamoya angiopathy

Larger Posterior Revascularization Associated with Reduction of Choroidal Anastomosis in Moyamoya Disease: A Quantitative Angiographic Analysis

Increased abundance of Ruminococcus gnavus in gut microbiota is associated with moyamoya disease and non-moyamoya intracranial large artery disease

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