Trends in the Incidence and Treatment of Cerebrovascular Diseases in Korea : Part II. Cerebral Infarction, Cerebral Arterial Stenosis, and Moyamoya Disease

Abstract

Objective : To analyze trends in the incidence and treatment of diseases associated with ischemic stroke, namely, cerebral infarction (CI), cerebral arterial stenosis (CASTN), and moyamoya disease (MMD), based on Korean National Health Insurance Service (NHIS) data from 2008 to 2016. Methods : Data was extracted from the national health-claim database provided by the NHIS for 2008-2016 using International Classification of Diseases codes. The crude and age-standardized incidences of each disease (CI, CASTN without a history of CI, and MMD) were calculated; additional analyses were conducted according to age and sex. Trends in the number of patients undergoing treatment according to treatment method were analyzed for each disease using the Korean Classification of Diseases procedure codes. Results : In 2016, the total number of adults with newly diagnosed CI was 83939, reflecting a 9.4% decrease from that in 2008. The agestandardized incidence of CI in adults was 153.2 per 100000 person-years in 2016, reflecting a 37.2% decrease from that in 2008, while that of CASTN was 167.3 per 100000 person-years in 2016, reflecting a 73.3% increase from that in 2008. Among treated cases, the number of patients who underwent intra-arterial (IA) treatment, including IA fibrinolysis and mechanical thrombectomy, showed the most prominent increase, increasing at an annual rate of 25.8%. For CASTN, the number of cases treated with carotid artery stenting or balloon angioplasty (CAS) showed the most prominent increase, increasing at a rate of 69.8% over the 9-year period. For MMD, the total number of patients with newly diagnosed MMD and that with adult MMD demonstrated significantly increasing trends, while the number of pediatric patients with newly diagnosed MMD declined by 18.0% over the 9-year period. The age-standardized incidences of pediatric and adult MMD in 2016 were 2.4 and 3.4 per 100000 person-years, respectively. Conclusion : Although the incidence of CI showed a declining trend over a 9-year period, the number and proportion of patients treated for CI increased. Meanwhile, the incidence of CASTN and the number of patients treated for CASTN have demonstrated increasing trends since 2008. On the other hand, the number of patients diagnosed with pediatric MMD decreased, despite no significant change in the incidence. In contrast, the number of patients and the incidence of adult MMD increased. These trends reflect changes in the population structure, gains in the accessibility of imaging examinations, and the development of endovascular techniques. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Incidence and prevalence of moyamoya disease in urban China: a nationwide retrospective cohort study

“… 7 8 A similar phenomenon also existed in Korea. 30 However, a routine DSA and MRI check-up for a large population is impossible in China due to insufficient healthcare resources and limited financial capability. 31 32 Some asymptomatic patients do not even realise the fact that they suffer from MMD, let alone be diagnosed with MMD.…”

Trends in Mortality from Hemorrhagic Stroke in Korea from 2012 to 2020

“…According to a previous study, the incidence of unruptured intracranial aneurysms (UIAs) in Korea has steadily increased, and the incidence of SAH has gradually decreased. 9,10 As UIAs are treated before SAH, this tendency could reduce the incidence and mortality of SAH. In a previous study, a crude incidence of SAH in 2008 and 2016 was 16.8 per 100,000 person-years and 15.5 per 100,000 person-years, respectively.…”

“…10 Therefore, it is possible that these findings could be due to an increase in the treatment of UIAs and the management of hypertension through health screening. 10,11 In cases of ICH, the mortality rate also decreased. However, it still showed a higher mortality rate than SAH, with respect to age and sex, as shown in previous studies.…”

Angiographic Characteristics of Cerebral Perfusion and Hemodynamics of the Bridging Artery After Surgical Treatment of Unilateral Moyamoya Disease

“…Moyamoya disease (MMD) is a chronic occlusive intracranial arterial disease of unknown etiology with the characteristics of steno–occlusive alterations at the terminal portions of the internal carotid artery and an abnormal vascular network at the base of the brain ( Suzuki and Takaku, 1969 ; Kato et al, 2019 ; Chen et al, 2020 ; Lee et al, 2020 ). In a Japanese survey, patients with MMD generally have bilateral involvement while some patients also manifest as unilateral involvement ( Kuriyama et al, 2008 ).…”