Rapid Progression of Unilateral Moyamoya Disease

Kim, Tae‐Wan; Seo, Bo-Ra; Kim, Jae Hyoo; Kim, Young Ok

doi:10.3340/jkns.2011.49.1.65

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…The age group with the highest incidence of moyamoya disease is 0-10 years old, followed by 30-50 years old (6,(28)(29)(30). In addition, it is reported that children with unilateral often exhibit progression to typical bilateral MMD (31). In 2011, Yeon et al (22) reported that contralateral progression was mostly observed in patients under the age of 9 years old and they developed contralateral lesions within 3 years after the initial diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Potential predictors for progression of moyamoya disease: A systematic review and meta-analysis

Cao

Xing²,

Dai³

et al. 2023

Front. Neurol.

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BackgroundThe progress of Moyamoya disease (MMD) is often accompanied by the occurrence of new ischemia or hemorrhagic events, which was difficult to predict. This systematic review and meta-analysis aimed to identify predictors for progression in MMD patients.MethodsWe searched PubMed, Web of Science, Cochrane Library, and Embase databases up to December 10th, 2022 for randomized controlled trials, case-control studies, or cohort studies reporting predictors of disease progression in MMD patients. The results of each predictor were pooled by meta-analysis and further analyzed by subgroup analysis for predictors of unilateral to bilateral progression of MMD.ResultsA total of 842 patients from 12 studies were included. The estimated pooled means indicated lower age (standard mean difference [SMD]: −0.29, 95% confidence interval [CI]: −0.55 to −0.03; P = 0.03), family history (odds ratio [OR] 3.97, 95% CI: 1.96 to 8.03; P < 0.001) and contralateral abnormality (OR 3.95, 95% CI: 1.10 to 14.20; P = 0.04) were associated with progression in MMD patients. Subgroup analyses indicated that the same three factors were associated with the progression of unilateral to bilateral MMD.ConclusionsThis meta-analysis revealed that lower age, family history and contralateral abnormality were associated with progression in MMD patients. The same three factors are associated with the progression of unilateral to bilateral MMD. Further studies are needed to validate our results.

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Section: Discussionmentioning

confidence: 99%

Potential predictors for progression of moyamoya disease: A systematic review and meta-analysis

Cao

Xing²,

Dai³

et al. 2023

Front. Neurol.

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“…These studies might also reveal the statistical significance of other variables such as preexisting infarct. Considering the devastating nature of unstable moyamoya disease reported to date, 4,17,18 early surgical revascularization might be recommended. Kim et al similarly stressed the importance of early surgical intervention for aggressive moyamoya disease observed in children.…”

Section: Discussionmentioning

confidence: 99%

“…4, 18 Kim et al reported that younger patients were more likely to suffer from an aggressive clinical course, of whom a substantial number experienced repeat stroke. 17 While the impact of such unstable disease on clinical outcome is receiving more focused attention, few studies have attempted to clearly define this condition.…”

mentioning

confidence: 99%

“…Accurate risk stratification in moyamoya disease requires objective definition of disease instability. According to the articles mentioned above, 4,17,18 disease progression and repeat stroke are considered essential factors reflecting instability of moyamoya disease. The concept of unstable moyamoya disease defined as either rapid disease progression or repeat stroke seems reasonable, considering that unstable angina pectoris, the concept representing instability of angina pectoris, is also characterized as an exacerbating or recurrent symptom with rapid progression of stenosis in the coronary artery.…”

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confidence: 99%

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Unstable moyamoya disease: clinical features and impact on perioperative ischemic complications

Funaki¹,

Takahashi²,

Takagi³

et al. 2015

JNS

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A mAjor characteristic of moyamoya disease is the chronic progression of stenosis in the terminal portion of the internal carotid artery (ICA). 24 The rate of this progression varies by patient. Angiographic progression can occur in one-half of pediatric patients and one-quarter of adult patients, 19,21 while angiographic findings in the remaining patients are stable for years. Some patients demonstrate extremely rapid progression from disease onset, resulting in poor outcome. obJect Unstable moyamoya disease, reasonably defined as cases exhibiting either rapid disease progression or repeated ischemic stroke, represents a challenge in the treatment of moyamoya disease. Despite its overall efficacy, direct bypass for such unstable disease remains controversial in terms of safety. This study aims to reveal factors associated with unstable disease and to assess its impact on postoperative silent or symptomatic ischemic lesions. methods This retrospective cohort study included both pediatric and adult patients with moyamoya disease who had undergone 140 consecutive direct bypass procedures at Kyoto University Hospital. "Unstable moyamoya disease" was defined as either the rapid progression of a steno-occlusive lesion or repeat ischemic stroke, either occurring within 6 months of surgery. The extent of progression was determined through a comparison of the findings between 2 different MR angiography sessions performed before surgery. The clinical variables of the stable and unstable disease groups were compared, and the association between unstable disease and postoperative diffusion-weighted imaging (DWI)-detected lesion was assessed through univariate and multivariate analyses with generalized estimating equations. results Of 134 direct bypass procedures performed after patients had undergone at least 2 sessions of MR angiography, 24 (17.9%) were classified as cases of unstable disease. Age younger than 3 years (p = 0.029), underlying disease causing moyamoya syndrome (p = 0.049), and radiographic evidence of infarction (p = 0.030) were identified as factors associated with unstable disease. Postoperative DWI-defined lesions were detected after 13 of 140 procedures (9.3%), although only 4 lesions (2.9%) could be classified as a permanent complication. coNclusioNs Unstable moyamoya disease, more prevalent in younger patients and those with underlying disease, is a possible risk factor for perioperative ischemic complications. Recognition of unstable moyamoya disease may contribute to an improved surgical result through focused perioperative management based on appropriate surgical risk stratification.

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“…Monitoring Collateral Circulation: TCD can assess the development and function of collateral circulation in patients with Moyamoya disease. By measuring blood flow velocities in the collateral vessels, TCD can provide information about the adequacy of collateral circulation and its contribution to cerebral per-World Journal of Neuroscience fusion [47] [48].…”

Section: Transcranial Doppler (Tcd)mentioning

confidence: 99%

Recent Advances for Global Perspectives on Etiology, Pathophysiology, Clinical Presentations, and Management of Moyamoya Disease

Mkwambe,

Zhao,

Deng

2024

WJNS

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Moyamoya disease (MMD) is a condition characterized by the gradual narrowing and blockage of blood vessels in the brain, specifically those in the circle of Willis and the arteries that supply it. This results in reduced blood flow and oxygen to the brain, leading to progressive symptoms and potential complications. The underlying pathophysiological mechanism remains elucidated. However, recent studies have highlighted numerous etiologic factors: abnormal immune complex responses, susceptibility genes, branched-chain amino acids, antibodies, heritable diseases, and acquired diseases, which may be the great potential triggers for the development of moyamoya disease. Its clinical presentation has varying degrees from transient asymptomatic events to significant neurological deficits. Moyamoya disease (MMD) shows different patterns in children and adults. Children with MMD are more susceptible to ischemic events due to decreased blood flow to the brain. Conversely, adults with MMD are more prone to hemorrhagic events involving brain bleeding. Children with MMD may experience a range of symptoms including motor impairments, sensory issues, seizures, headaches, dizziness, cognitive delays, or ongoing neurological problems. Although adults may present with similar clinical symptoms as children, they are more prone to experiencing sudden onset intraventricular, subarachnoid, or intracerebral hemorrhages. One of the challenges in moyamoya disease is the potential for misdiagnosis or delayed diagnosis, particularly when physicians fail to consider MMD as a possible cause in stroke patients. This review aims to provide a comprehensive overview of recent global studies on the pathophysiology of MMD, along with advancements in its management. Additionally, the review will delve into various surgical treatment options for MMD, as well as its rare

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Rapid Progression of Unilateral Moyamoya Disease

Cited by 8 publications

References 13 publications

Potential predictors for progression of moyamoya disease: A systematic review and meta-analysis

Potential predictors for progression of moyamoya disease: A systematic review and meta-analysis

Unstable moyamoya disease: clinical features and impact on perioperative ischemic complications

Recent Advances for Global Perspectives on Etiology, Pathophysiology, Clinical Presentations, and Management of Moyamoya Disease

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