Intractable Medial Anastomotic Branches from the Lenticulostriate Artery Causing Recurrent Hemorrhages in Moyamoya Disease

Sasagasako, Tomoki; Funaki, Takeshi; Tanji, Masahiro; Arakawa, Yoshiki; Suzuki, Hime; Miyakoshi, Akinori; Miyamoto, Susumu

doi:10.1016/j.wneu.2019.04.066

Cited by 14 publications

(6 citation statements)

References 9 publications

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“…[2][3][4] Development of such collateral vessels represents a risk factor for intracerebral hemorrhage, 3,[5][6][7] and these vessels have frequently been considered as the vessels responsible for bleeding in recent reports. [8][9][10] These collateral vessels connect with medullary arteries near the lateral ventricle and thus supply the cortex via the medullary arteries. 3,4 However, no reports have addressed the cortical distributions of these collateral vessels.…”

Section: Resultsmentioning

confidence: 99%

“…10 Some reports have also discussed ruptured aneurysms arising on dilated and extended LSAs. 9,20,21 These aneurysms supposedly develop due to an increase in the hemodynamic burden, to supply the cortex via collaterals in place of shrunken major arteries. 9,20,21 Furthermore, Takahashi et al 22 estimated LSAs as possible sources of anterior hemorrhage in a subanalysis of the Japan Adult Moyamoya Trial.…”

Section: Discussionmentioning

confidence: 99%

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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

Miyakoshi¹,

Funaki²,

Fushimi³

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Collateral vessels in Moyamoya disease represent potential sources of bleeding. To test whether these cortical distributions vary among subtypes, we investigated cortical terminations using both standardized MR imaging and MRA. MATERIALS AND METHODS: Patients with Moyamoya disease who underwent MR imaging with MRA in our institution were enrolled in this study. MRA was spatially normalized to the Montreal Neurological Institute space; then, collateral vessels were measured on MRA and classified into 3 types of anastomosis according to the parent artery: lenticulostriate, thalamic, and choroidal. We also obtained the coordinates of collateral vessel outflow to the cortex. Differences in cortical terminations were compared among the 3 types of anastomosis.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Miyakoshi¹,

Funaki²,

Fushimi³

et al. 2020

AJNR Am J Neuroradiol

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“…If the responsible vessel enlarges with time, tailored bypass may be able to shrink the vessel and prevent rebleeding. 26 This study had several limitations that must be considered when interpreting the results. First, although we defined the bleeding point as the point at which the signal from abnormally extended vessel on TOF-MRA overlapped the area of hypointensity on SWI, demonstrating whether this vessel had actually been disrupted is difficult.…”

Section: Discussionmentioning

confidence: 96%

Identification of the Bleeding Point in Hemorrhagic Moyamoya Disease Using Fusion Images of Susceptibility-Weighted Imaging and Time-of-Flight MRA

Miyakoshi¹,

Funaki²,

Fushimi

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: The location of intracerebral hemorrhage in Moyamoya disease is a prognostic factor for rebleeding and the degree of preventive effects obtainable with bypass surgery. We evaluated whether the bleeding point and responsible vessel were detectable using fusion images of SWI and time-of-flight MRA performed during chronic-phase hemorrhage. MATERIALS AND METHODS: We retrospectively enrolled 42 patients with hemorrhagic Moyamoya disease (48 hemorrhagic events). Fusion images of SWI and MRA were made using workstations, and we defined the bleeding point as the point at which the signal of an abnormally extended artery on MRA overlapped the hypointense area on SWI. Two independent raters identified the bleeding point, and classified the location and responsible vessels. RESULTS: The bleeding point was detectable at a frequency of 79.2% by rater 1. Agreement for the presence of a bleeding point was high (interrater k = 0.83; 95% CI, 0.65-1; intrarater k = 0.86; 95% CI, 0.68-1). The frequency of a periventricular location of the bleeding point was 65.8% by rater 1, and agreement on the location was again high (interrater k = 0.92; 95% CI, 0.82-1; intrarater k = 0.85; 95% CI, 0.72-0.99). The choroidal artery was the most frequent responsible vessel (57.9% by rater 1), and agreement on the responsible vessel was high (interrater k = 0.84; 95% CI, 0.69-1; intrarater k = 0.90; 95% CI, 0.78-1). CONCLUSIONS: Detection of the bleeding point in hemorrhagic Moyamoya disease using SWI and MRA fusion images offers highly reproducible results.

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“…It might mean direct bypass may have a role in both patients with GA and GG. Whereas patients with GA had more lenticulostriate anastomosis, recent study showed that lenticulostriate anastomosis in hemorrhagic MMD was less likely to diminish than other collaterals after successful direct bypass [27]. It suggested that patients with GA variants should be given more attention to surgical planning, and the bypass surgery should target the area reached by collateral vessels.…”

Section: Discussionmentioning

confidence: 99%

Different subtypes of collateral vessels in hemorrhagic moyamoya disease with p.R4810K variant

Zhang

et al. 2020

BMC Neurol

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Background: The aim of this study was to investigate the hemorrhgic sites and collateral vessels in hemorrhagic MMD with the p.R4810K variant. Methods: Hemorrhage sites were classified as either anterior or posterior. Collateral vessels were classified into three subtypes according to origin: lenticulostriate anastomosis, thalamic anastomosis, and choroidal anastomosis. Hemorrhage sites and collateral vessels were compared between patients with wild-type p.R4810K variant (GG) and patients with heterozygous p.R4810K variant (GA) after 1:1 propensity score matching. Results: A total of 130 hemorrhagic MMD patients were included in present study, 21 pairs (42 hemorrhagic hemispheres) were obtained after 1:1 propensity score. In GA group, 16 hemispheres (76.2%) presented anterior hemorrhage, and 5 hemispheres (23.8%) presented with posterior hemorrhage. In GG group, 13 hemispheres (61.9%) presented anterior hemorrhage, and 8 hemispheres (38.1%) presented with posterior hemorrhage. No significant differences were found in hemorrhagic sites between two matched groups (P > 0.05). Of 21 hemispheres in GA group, 10 (47.6%) exhibited lenticulostriate anastomosis, 6 (28.6%) thalamic anastomosis, and 6 (28.6%) choroidal anastomosis. Of 21 hemispheres in GG group, 3 (14.3%) exhibited lenticulostriate anastomosis, 5 (23.8%) thalamic anastomosis, and 9 (42.9%) choroidal anastomosis. There was significant difference in lenticulostriate anastomosis between two matched groups (P = 0.045). After adjustment the age, sex, and PCA involvement, we found that lenticulostriate anastomosis was associated with p.R4810K variant (OR, 5.995; 95% CI, 1.296-27.737; P = 0.022). Conclusion: Lenticulostriate anastomosis might be associated with p.R4810K variant. Whereas hemorrhagic sites, thalamic anastomosis, and choroidal anastomosis might not be associted withp.R4810K variant.

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Intractable Medial Anastomotic Branches from the Lenticulostriate Artery Causing Recurrent Hemorrhages in Moyamoya Disease

Cited by 14 publications

References 9 publications

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

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

Identification of the Bleeding Point in Hemorrhagic Moyamoya Disease Using Fusion Images of Susceptibility-Weighted Imaging and Time-of-Flight MRA

Different subtypes of collateral vessels in hemorrhagic moyamoya disease with p.R4810K variant

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