Cerebrovascular Events during Pregnancy and Puerperium Resulting from Preexisting Moyamoya Disease: Determining the Risk of Ischemic Events Based on Hemodynamic Status Assessment Using Brain Perfusion Single-Photon Emission Computed Tomography

Si Un Lee, Young Seob Chung, Chang Wan Oh, O. Ki Kwon, Jae Seung Bang, Gyojun Hwang, Tackeun Kim, Seong Yeol Ahn

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective The purposes of this study were to review the cerebrovascular events (CVE) during pregnancy and puerperium in adults with moyamoya disease (MMD) and to evaluate its risk factors. Methods We reviewed electronic medical records on 141 pregnancies in 71 women diagnosed with MMD and this study included only 27 pregnancies (23 patients) diagnosed with MMD before pregnancy. Basal and acetazolamide-stress brain perfusion single-photon emission computed tomography (SPECT) was conducted for 40 hemispheres in 21 pregnancies within 1 year of the gestational period, ranging from 22 months before delivery to 12 months after delivery for evaluation of the hemodynamic status of the patients to devise the MMD treatment strategy. Results Twelve pregnancies (44.4%) showed CVE during pregnancy or puerperium in the group diagnosed with MMD before pregnancy. All the 12 CVE were ischemic, without any hemorrhagic events. A decreased cerebral vascular reserve capacity (CVRC) on stress SPECT was observed in 25 (62.5%) of the 40 hemispheres, and 18 of these 25 hemispheres showed TIA. In contrast, only 2 of 15 hemispheres which revealed normal CVRC on stress SPECT showed TIA. Overall, a decreased CVRC on stress SPECT imaging was statistically associated with development of CVE (P < 0.001). Furthermore, the clinical type of MMD was also regarded as predictive factor for CVE in this study. Especially, ischemic type MMD revealed a statistical association with the development of CVE (P = 0.014, odds ratio = 16.50). Conclusions Assessment of cerebral hemodynamic status with stress SPECT may predict CVE during pregnancy and puerperium.

Original languageEnglish
Pages (from-to)66-75
Number of pages10
JournalWorld Neurosurgery
Volume90
DOIs
StatePublished - Jun 2016

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Moyamoya Disease
Preexisting Condition Coverage
Single-Photon Emission-Computed Tomography
Postpartum Period
Perfusion
Hemodynamics
Pregnancy
Brain
Blood Vessels
Acetazolamide
Electronic Health Records
Odds Ratio

Keywords

  • Cerebral vascular reserve capacity
  • Cerebrovascular events
  • Moyamoya disease
  • Pregnancy
  • Puerperium

Cite this

@article{9370764d47ac48569c70e1bd61693939,
title = "Cerebrovascular Events during Pregnancy and Puerperium Resulting from Preexisting Moyamoya Disease: Determining the Risk of Ischemic Events Based on Hemodynamic Status Assessment Using Brain Perfusion Single-Photon Emission Computed Tomography",
abstract = "Objective The purposes of this study were to review the cerebrovascular events (CVE) during pregnancy and puerperium in adults with moyamoya disease (MMD) and to evaluate its risk factors. Methods We reviewed electronic medical records on 141 pregnancies in 71 women diagnosed with MMD and this study included only 27 pregnancies (23 patients) diagnosed with MMD before pregnancy. Basal and acetazolamide-stress brain perfusion single-photon emission computed tomography (SPECT) was conducted for 40 hemispheres in 21 pregnancies within 1 year of the gestational period, ranging from 22 months before delivery to 12 months after delivery for evaluation of the hemodynamic status of the patients to devise the MMD treatment strategy. Results Twelve pregnancies (44.4{\%}) showed CVE during pregnancy or puerperium in the group diagnosed with MMD before pregnancy. All the 12 CVE were ischemic, without any hemorrhagic events. A decreased cerebral vascular reserve capacity (CVRC) on stress SPECT was observed in 25 (62.5{\%}) of the 40 hemispheres, and 18 of these 25 hemispheres showed TIA. In contrast, only 2 of 15 hemispheres which revealed normal CVRC on stress SPECT showed TIA. Overall, a decreased CVRC on stress SPECT imaging was statistically associated with development of CVE (P < 0.001). Furthermore, the clinical type of MMD was also regarded as predictive factor for CVE in this study. Especially, ischemic type MMD revealed a statistical association with the development of CVE (P = 0.014, odds ratio = 16.50). Conclusions Assessment of cerebral hemodynamic status with stress SPECT may predict CVE during pregnancy and puerperium.",
keywords = "Cerebral vascular reserve capacity, Cerebrovascular events, Moyamoya disease, Pregnancy, Puerperium",
author = "Lee, {Si Un} and Chung, {Young Seob} and Oh, {Chang Wan} and Kwon, {O. Ki} and Bang, {Jae Seung} and Gyojun Hwang and Tackeun Kim and Ahn, {Seong Yeol}",
year = "2016",
month = "6",
doi = "10.1016/j.wneu.2016.02.062",
language = "English",
volume = "90",
pages = "66--75",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Cerebrovascular Events during Pregnancy and Puerperium Resulting from Preexisting Moyamoya Disease

T2 - Determining the Risk of Ischemic Events Based on Hemodynamic Status Assessment Using Brain Perfusion Single-Photon Emission Computed Tomography

AU - Lee, Si Un

AU - Chung, Young Seob

AU - Oh, Chang Wan

AU - Kwon, O. Ki

AU - Bang, Jae Seung

AU - Hwang, Gyojun

AU - Kim, Tackeun

AU - Ahn, Seong Yeol

PY - 2016/6

Y1 - 2016/6

N2 - Objective The purposes of this study were to review the cerebrovascular events (CVE) during pregnancy and puerperium in adults with moyamoya disease (MMD) and to evaluate its risk factors. Methods We reviewed electronic medical records on 141 pregnancies in 71 women diagnosed with MMD and this study included only 27 pregnancies (23 patients) diagnosed with MMD before pregnancy. Basal and acetazolamide-stress brain perfusion single-photon emission computed tomography (SPECT) was conducted for 40 hemispheres in 21 pregnancies within 1 year of the gestational period, ranging from 22 months before delivery to 12 months after delivery for evaluation of the hemodynamic status of the patients to devise the MMD treatment strategy. Results Twelve pregnancies (44.4%) showed CVE during pregnancy or puerperium in the group diagnosed with MMD before pregnancy. All the 12 CVE were ischemic, without any hemorrhagic events. A decreased cerebral vascular reserve capacity (CVRC) on stress SPECT was observed in 25 (62.5%) of the 40 hemispheres, and 18 of these 25 hemispheres showed TIA. In contrast, only 2 of 15 hemispheres which revealed normal CVRC on stress SPECT showed TIA. Overall, a decreased CVRC on stress SPECT imaging was statistically associated with development of CVE (P < 0.001). Furthermore, the clinical type of MMD was also regarded as predictive factor for CVE in this study. Especially, ischemic type MMD revealed a statistical association with the development of CVE (P = 0.014, odds ratio = 16.50). Conclusions Assessment of cerebral hemodynamic status with stress SPECT may predict CVE during pregnancy and puerperium.

AB - Objective The purposes of this study were to review the cerebrovascular events (CVE) during pregnancy and puerperium in adults with moyamoya disease (MMD) and to evaluate its risk factors. Methods We reviewed electronic medical records on 141 pregnancies in 71 women diagnosed with MMD and this study included only 27 pregnancies (23 patients) diagnosed with MMD before pregnancy. Basal and acetazolamide-stress brain perfusion single-photon emission computed tomography (SPECT) was conducted for 40 hemispheres in 21 pregnancies within 1 year of the gestational period, ranging from 22 months before delivery to 12 months after delivery for evaluation of the hemodynamic status of the patients to devise the MMD treatment strategy. Results Twelve pregnancies (44.4%) showed CVE during pregnancy or puerperium in the group diagnosed with MMD before pregnancy. All the 12 CVE were ischemic, without any hemorrhagic events. A decreased cerebral vascular reserve capacity (CVRC) on stress SPECT was observed in 25 (62.5%) of the 40 hemispheres, and 18 of these 25 hemispheres showed TIA. In contrast, only 2 of 15 hemispheres which revealed normal CVRC on stress SPECT showed TIA. Overall, a decreased CVRC on stress SPECT imaging was statistically associated with development of CVE (P < 0.001). Furthermore, the clinical type of MMD was also regarded as predictive factor for CVE in this study. Especially, ischemic type MMD revealed a statistical association with the development of CVE (P = 0.014, odds ratio = 16.50). Conclusions Assessment of cerebral hemodynamic status with stress SPECT may predict CVE during pregnancy and puerperium.

KW - Cerebral vascular reserve capacity

KW - Cerebrovascular events

KW - Moyamoya disease

KW - Pregnancy

KW - Puerperium

UR - http://www.scopus.com/inward/record.url?scp=84961923938&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2016.02.062

DO - 10.1016/j.wneu.2016.02.062

M3 - Article

C2 - 26906896

AN - SCOPUS:84961923938

VL - 90

SP - 66

EP - 75

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -