Sonographic findings associated with stenosis progression and vascular complications in Moyamoya Disease

Woo Jin Lee, Keun Hwa Jung, Keon Joo Lee, Jeong Min Kim, Soon Tae Lee, Kon Chu, Sang Kun Lee, Jae Kyu Roh

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVE: The Progression of arterial stenosis in patients with moyamoya disease (MMD) has variable courses and an unclear mechanism. The authors hypothesized that elevated wall shear stress (WSS) at the terminal internal carotid artery (ICA) and proximal middle cerebral artery (MCA) may facilitate MMD progression. They indirectly evaluated the relative magnitude of WSS (WSS value [WSSV]) with MR angiography (MRA) and transcranial Doppler to determine its predictive value for stenosis progression (SP) and the development of vascular complications. METHODS: Thirty-one medically treated patients (58 hemispheres and 95 nonoccluded vessels) were analyzed with serial MRA (median follow-up 23 months). The parameters studied were SP, SP rates (SPRs) for individual ICAs/MCAs, and their mean values from the ipsilateral hemispheres as mean SP (MSP) and MSP rates (MSPRs). Significant progression was defined as decrements of ≥ 20% for SP and MSP and ≥ 10%/year for SPR and MSPR. The development of vascular complications in relevant hemispheres was also recorded. The WSSV (dyne/cm 2 ) was defined as the shear rate multiplied by blood viscosity. RESULTS: After adjusting the initial stenosis degree and MRA stage of MMD, an SP of ≥ 20% and an SPR of ≥ 10%/year were associated with the highest-quartile WSSVs for all individual vessels and for MCAs and ICAs separately. For each hemisphere, an MSP of ≥ 20% and an MSPR of ≥ 10%/year were associated with the highest-quartile mean WSSVs. Furthermore, significant SP was highly correlated with vascular complications, and the highest-quartile mean WSSV was independently associated with vascular complications in relevant hemispheres. CONCLUSIONS: An elevated WSSV is an independent predictor for SP and vascular complications in nonoccluded MMD.

Original languageEnglish
Pages (from-to)689-697
Number of pages9
JournalJournal of Neurosurgery
Volume125
Issue number3
DOIs
StatePublished - Sep 2016

Fingerprint

Moyamoya Disease
Blood Vessels
Pathologic Constriction
Angiography
Disease Progression
Blood Viscosity
Middle Cerebral Artery
Internal Carotid Artery

Keywords

  • Angiography
  • Moyamoya disease
  • Progression
  • Transcranial Doppler
  • Vascular disorders
  • Vascular remodeling
  • Wall shear stress

Cite this

@article{8229e7acf63a41ee885092cf1916d103,
title = "Sonographic findings associated with stenosis progression and vascular complications in Moyamoya Disease",
abstract = "OBJECTIVE: The Progression of arterial stenosis in patients with moyamoya disease (MMD) has variable courses and an unclear mechanism. The authors hypothesized that elevated wall shear stress (WSS) at the terminal internal carotid artery (ICA) and proximal middle cerebral artery (MCA) may facilitate MMD progression. They indirectly evaluated the relative magnitude of WSS (WSS value [WSSV]) with MR angiography (MRA) and transcranial Doppler to determine its predictive value for stenosis progression (SP) and the development of vascular complications. METHODS: Thirty-one medically treated patients (58 hemispheres and 95 nonoccluded vessels) were analyzed with serial MRA (median follow-up 23 months). The parameters studied were SP, SP rates (SPRs) for individual ICAs/MCAs, and their mean values from the ipsilateral hemispheres as mean SP (MSP) and MSP rates (MSPRs). Significant progression was defined as decrements of ≥ 20{\%} for SP and MSP and ≥ 10{\%}/year for SPR and MSPR. The development of vascular complications in relevant hemispheres was also recorded. The WSSV (dyne/cm 2 ) was defined as the shear rate multiplied by blood viscosity. RESULTS: After adjusting the initial stenosis degree and MRA stage of MMD, an SP of ≥ 20{\%} and an SPR of ≥ 10{\%}/year were associated with the highest-quartile WSSVs for all individual vessels and for MCAs and ICAs separately. For each hemisphere, an MSP of ≥ 20{\%} and an MSPR of ≥ 10{\%}/year were associated with the highest-quartile mean WSSVs. Furthermore, significant SP was highly correlated with vascular complications, and the highest-quartile mean WSSV was independently associated with vascular complications in relevant hemispheres. CONCLUSIONS: An elevated WSSV is an independent predictor for SP and vascular complications in nonoccluded MMD.",
keywords = "Angiography, Moyamoya disease, Progression, Transcranial Doppler, Vascular disorders, Vascular remodeling, Wall shear stress",
author = "Lee, {Woo Jin} and Jung, {Keun Hwa} and Lee, {Keon Joo} and Kim, {Jeong Min} and Lee, {Soon Tae} and Kon Chu and Lee, {Sang Kun} and Roh, {Jae Kyu}",
year = "2016",
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language = "English",
volume = "125",
pages = "689--697",
journal = "Journal of neurosurgery",
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Sonographic findings associated with stenosis progression and vascular complications in Moyamoya Disease. / Lee, Woo Jin; Jung, Keun Hwa; Lee, Keon Joo; Kim, Jeong Min; Lee, Soon Tae; Chu, Kon; Lee, Sang Kun; Roh, Jae Kyu.

In: Journal of Neurosurgery, Vol. 125, No. 3, 09.2016, p. 689-697.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Sonographic findings associated with stenosis progression and vascular complications in Moyamoya Disease

AU - Lee, Woo Jin

AU - Jung, Keun Hwa

AU - Lee, Keon Joo

AU - Kim, Jeong Min

AU - Lee, Soon Tae

AU - Chu, Kon

AU - Lee, Sang Kun

AU - Roh, Jae Kyu

PY - 2016/9

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N2 - OBJECTIVE: The Progression of arterial stenosis in patients with moyamoya disease (MMD) has variable courses and an unclear mechanism. The authors hypothesized that elevated wall shear stress (WSS) at the terminal internal carotid artery (ICA) and proximal middle cerebral artery (MCA) may facilitate MMD progression. They indirectly evaluated the relative magnitude of WSS (WSS value [WSSV]) with MR angiography (MRA) and transcranial Doppler to determine its predictive value for stenosis progression (SP) and the development of vascular complications. METHODS: Thirty-one medically treated patients (58 hemispheres and 95 nonoccluded vessels) were analyzed with serial MRA (median follow-up 23 months). The parameters studied were SP, SP rates (SPRs) for individual ICAs/MCAs, and their mean values from the ipsilateral hemispheres as mean SP (MSP) and MSP rates (MSPRs). Significant progression was defined as decrements of ≥ 20% for SP and MSP and ≥ 10%/year for SPR and MSPR. The development of vascular complications in relevant hemispheres was also recorded. The WSSV (dyne/cm 2 ) was defined as the shear rate multiplied by blood viscosity. RESULTS: After adjusting the initial stenosis degree and MRA stage of MMD, an SP of ≥ 20% and an SPR of ≥ 10%/year were associated with the highest-quartile WSSVs for all individual vessels and for MCAs and ICAs separately. For each hemisphere, an MSP of ≥ 20% and an MSPR of ≥ 10%/year were associated with the highest-quartile mean WSSVs. Furthermore, significant SP was highly correlated with vascular complications, and the highest-quartile mean WSSV was independently associated with vascular complications in relevant hemispheres. CONCLUSIONS: An elevated WSSV is an independent predictor for SP and vascular complications in nonoccluded MMD.

AB - OBJECTIVE: The Progression of arterial stenosis in patients with moyamoya disease (MMD) has variable courses and an unclear mechanism. The authors hypothesized that elevated wall shear stress (WSS) at the terminal internal carotid artery (ICA) and proximal middle cerebral artery (MCA) may facilitate MMD progression. They indirectly evaluated the relative magnitude of WSS (WSS value [WSSV]) with MR angiography (MRA) and transcranial Doppler to determine its predictive value for stenosis progression (SP) and the development of vascular complications. METHODS: Thirty-one medically treated patients (58 hemispheres and 95 nonoccluded vessels) were analyzed with serial MRA (median follow-up 23 months). The parameters studied were SP, SP rates (SPRs) for individual ICAs/MCAs, and their mean values from the ipsilateral hemispheres as mean SP (MSP) and MSP rates (MSPRs). Significant progression was defined as decrements of ≥ 20% for SP and MSP and ≥ 10%/year for SPR and MSPR. The development of vascular complications in relevant hemispheres was also recorded. The WSSV (dyne/cm 2 ) was defined as the shear rate multiplied by blood viscosity. RESULTS: After adjusting the initial stenosis degree and MRA stage of MMD, an SP of ≥ 20% and an SPR of ≥ 10%/year were associated with the highest-quartile WSSVs for all individual vessels and for MCAs and ICAs separately. For each hemisphere, an MSP of ≥ 20% and an MSPR of ≥ 10%/year were associated with the highest-quartile mean WSSVs. Furthermore, significant SP was highly correlated with vascular complications, and the highest-quartile mean WSSV was independently associated with vascular complications in relevant hemispheres. CONCLUSIONS: An elevated WSSV is an independent predictor for SP and vascular complications in nonoccluded MMD.

KW - Angiography

KW - Moyamoya disease

KW - Progression

KW - Transcranial Doppler

KW - Vascular disorders

KW - Vascular remodeling

KW - Wall shear stress

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