Characteristics And Clinical Significance Of Collateral Circulation In Adult Moyamoya Disease Based On Modified Suzuki Scoring

Background:Moyamoya disease(MMD)is a chronic,progressive cerebrovascular disease.It is characterized by bilateral stenosis or occlusion of the distal end of the internal carotid artery and its major branches,with anomalous skull base anomaly.In patients with MMD,cerebral ischemia in the performance of patients accounted for about 60%,and the age of onset showed a bimodal distribution phenomenon,the first peak is 5-9 years old,the second peak is 40 years old.About the performance of cerebral hemorrhage,about 20%of patients,the age of onset basically concentrated at the age of 40,into a single peak distribution.The relationship between cerebral blood flow patterns and stroke types in MMD patients is still controversial.Current research suggests that the expansion and fragile collateral vessels,and the rupture of the Capsular aneurysm of the Willis ring,are the two main causes of cerebral hemorrhage in patients with MMD.Blood flow-related aneurysms,anterior choroidal artery,and posterior communicating artery dilation are independent predictors of cerebral hemorrhage in patients with MMD.Studies have shown that the collateral compensatory system has an important protective effect on patients with ischemic stroke.When a cerebral ischemic event occurs,the body is compensated by various cerebral collaterals to rescue cerebral ischemia around the brain and relieve chronic cerebral ischemia.In the long-term chronic ischemia,patients with MMD trigger a variety of different types of collateral circulation.To explore the distribution pattern of collateral circulation in MMD patients is of great significance for understanding cerebral vascular compensation.In this study,we retrospectively analyzed clinical data and summarized the features of cerebral angiograms in MMD patients with different types of stroke.We compared the results with T-test analysis,one-way ANOVA test,chi-square test,and Fisher’s exact test.We try to find out some independent predictors of cerebral hemorrhage in patients with MMD.At the same time,we tried to establish a grouping of cerebrovascular collateral compensatory vasculature in moyamoya patients based on anatomy,and preliminarily studied the relationship between each subgroup and stroke type and the relationship with modified Suzuki grading.Methods:Collect information on all adult MMD patients who received DSA examination in our unit from 2006 to 2016.Double-blind analysis the imaging results from two groups,which were divided into ischemia group and bleeding group according to CT or MR examination results.The severity of the disease was graded using the modified Suzuki score.We describe four types of anastomotic networks in MMD,two superficial-meningeal and two deep-parenchymal.As superficial-meningeal,we defined the leptomeningeal and the durocortical networks.As deep-parenchymal networks We defined the subependymal networks and the inner striatal and inner thalamic networks.Spss 22.0 software was used to analyze the data,and the test level was a = 0.05.Results:There was no significant difference in the distribution of mSS scores between the hemorrhage group and the ischemic group(χ2 = 5.812,v = 5,P = 0.325).Pcom/ICA were statistically significant(t = 2.119,v = 108,p = 0.036),The ratio of hemorrhage group is larger.There was a significant difference in the ratio of Pcom/ICA between mSS score groups(f = 8.924,P = 0.00),and mSS score was higher at 3 and 4 groups.There was significant difference in the incidence of anterior choroidal artery dilation between the two groups(χ2:11.79,P = 0.001).There was no significant difference in the incidence of posterior cerebral artery disease between the two groups(χ2 = 1.117,P = 0.291).There was no statistically significant difference in the incidence of the durocortical networks between the two groups(χ2 = 0.327,P = 0.567).There was statistically significant difference in the incidence of the leptomeningeal networks between the two groups(Fisher exact test,P =0.018),There was no significant difference in the incidence of the subependymal networks between the two groups(χ2 = 0.011,P = 0.917).There was a significant difference in the incidence of the inner striatal and inner thalamic networks between the two groups(χ2 =7.551,P = 0.006)Conclusions:1 Collateral circulation vascular system is an important component of cerebral blood flow in MMD patients,which vary from patient to patient.2 Posterior communicating artery and internal carotid artery diameter ratio increases,abnormal expansion of the anterior choroidal artery,leptomeningeal networks and the inner striatal and inner thalamic networks is an independent risk factor for cerebral hemorrhage.3 Posterior cerebral artery changes in the case of higher mSS score.