Cerebrovascular Stenosis And Its Effect On Collaterals And Occurrence And Distribution Of Cerebral Infarction In Adlut Moyamoya Disease

Purpose:The purpose of this paper is to determine whether there is a relationship between steno-occlusive lesions in the anterior and posterior circulations,the influence of steno-ocelusive lesions on the collaterals and the prevalence and distribution of cerebral infarctions(CI)in audit patients with Moyamoya disease(MMD).Methods:The adlut patients with non-hemorrhagic-type Moyamoya Disease(n=37)who underwent digital subtraction angiography(DSA)and magnetic resonance imaging(MRI)in Nanjing Drum Tower Hospital were recruited consecutively.To evaluate the DSA findings for all 74 hemispheres,we classified steno-occlusive lesions of the anterior and posterior circulations into four angiographic stages with two angiographic staging systems for internal carotid artery(ICA)and posterior cerebral artery(PCA)defined by Mugikura et al.and the leptomeningeal collaterals from PCA into four grades according to their extent.we classified the transdural collaterals supplying individual hemispheres into 3 groups by their originating arteries and counted the number of the groups involved(0-3)in each hemisphere.We divided the cerebral hemispheres into the basal ganglia,the thalamus,and 6 corticosubcortical zones.The 6 corticosubcortical zones included the territory of the ACA,the ant-watershed(AWS),the anterior half of the territory of the middle cerebral artery(ant-MCA),the posterior half of the territory of the middle cerebral artery(post-MCA),the post-watershed(PWS),and the territory of the PCA.The occurrence of Cl and the number and distribution of the infarcted zones in each hemisphere were evaluated according to the MRI data.Then we analyzed the relationship of the ICA and PCA stages in the ipsilateral hemispheres,the correlation between the ICA/PCA stages and the collaterals,and the effect of the ICA/PCA stages and the collaterals on the prevalence,range(the number of infarcted zones)and distribution of CI.Results:1.The lesions with more advanced ICA and PCA stages were not on ipsilateral sides.2.We found a significantly positive correlation between the leptomeningeal collateral stages and ICA stages(P=0.039),but a significantly negative correlation between the leptomeningeal collateral stages and PCA stages(P<0.001,R=-0.478).The degree of transdural collaterals was significantly positively related to both ICA and PCA stages(P<0.001,P=0.036).3.PCA stage was an independent risk factor of the occurrence of CI(P=0.045,OR:2.498,95%CI:1.020-6.117).The hemispheres with more advanced PCA stages tended to have a higher prevalence of infarction(P=0.015)and have more infarcted zones(P=0.004),but the prevalence and range of CI were not associated with ICA stages,leptomeningeal collaterals and transdural eollaterals(P=0.099,P=0.396,P=0.266;P=0.243,P=0.673,P=0.677).The higher the PCA stages or the lower the leptomeningeal collateral stage,the higher the prevalence of CI in PWS and the PCA territory(P=0.001,P=0.005;P=0.036,P=0.010).The higher the leptomeningeal collateral stage,the higher the prevalence of CI in AWS(P=0.026).But the incidence of CI in AWS and the PCA territory was not associated with ICA stages and the degree of transdural collaterals.Conclusions:Our results indicated that the ipsilateral anterior and posterior circulations were not predominantly involved.With the progress of lesions of anterior and posterior circulations,the transdural collaterals gradually opened and became an important collateral compensatory pathways in late stages of Moyamoya disease eventually.The leptomeningeal collaterals from the PCA gradually increased with the progress of lesions of anterior circulations,but decreased with the progress of lesions of posterior circulations.Steno-occlusive lesions of posterior circulations can be important symbol of predicting high risk of Cl in MMD patients.With more advanced PCA lesions or less leptomeningeal collaterals infarcted zones tend to be found in the PCA territory and PWS.