1Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto.
2Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita.
J Neurosurg. 2018 Mar;128(3):777-784. doi: 10.3171/2016.11.JNS161650. Epub 2017 Apr 14.
OBJECTIVE In this paper, the authors set out to identify the angiographic features of moyamoya disease with posterior hemorrhage, which is a strong predictor of rebleeding. METHODS This cross-sectional study used the data set of the Japan Adult Moyamoya Trial (clinical trial registration no.: C000000166 [ www.umin.ac.jp/ctr/index.htm ]). The panel designed the ancillary measurement of angiography at onset, classifying the collateral vessels into 3 subtypes: lenticulostriate anastomosis, thalamic anastomosis, and choroidal anastomosis. The association between each collateral and the hemorrhage site (anterior vs posterior) was assessed in the hemorrhagic hemisphere by using multivariate adjustment for potential confounders, including age, sex, and involvement of the posterior cerebral artery (PCA). The association was confirmed through topographical analysis of bleeding points. RESULTS Among the 80 participants, 75 hemorrhagic hemispheres of 75 patients were analyzed. Lenticulostriate anastomosis was detected in 21 (28.0%) hemorrhagic hemispheres, thalamic anastomosis in 22 (29.3%), and choroidal anastomosis in 35 (46.7%). Choroidal anastomosis was a factor associated with posterior hemorrhage (OR 2.77 [95% CI 1.08-7.10], p = 0.034) and remained statistically significant after the multivariate adjustment (OR 2.66 [95% CI 1.00-7.07], p = 0.049). PCA involvement was also associated with posterior hemorrhage in both univariate and multivariate analyses. Topographical analysis revealed good correspondence between bleeding points associated with positive choroidal anastomosis and the anatomical distribution of the choroidal arteries, including the thalamus and the wall of the atrium. CONCLUSIONS Choroidal anastomosis and PCA involvement are characteristic of posterior hemorrhage in moyamoya disease. Choroidal anastomosis might be considered a potential source of posterior hemorrhage at high risk of rebleeding.
本文旨在确定伴有后部出血的烟雾病的血管造影特征，后部出血是再出血的强预测因素。
本横断面研究使用了日本成人烟雾病试验（临床试验注册编号：C000000166[www.umin.ac.jp/ctr/index.htm]）的数据。专家组设计了发病时的辅助血管造影测量，将侧支血管分为 3 个亚型：纹状体吻合、丘脑吻合和脉络膜吻合。通过多变量调整潜在混杂因素（包括年龄、性别和大脑后动脉（PCA）受累），评估每种侧支与出血部位（前部与后部）之间的关联。通过出血点的地形分析来确认关联。
在 80 名参与者中，分析了 75 名患者的 75 个出血半球。21 个（28.0%）出血半球发现纹状体吻合，22 个（29.3%）发现丘脑吻合，35 个（46.7%）发现脉络膜吻合。脉络膜吻合是与后部出血相关的因素（OR2.77[95%CI1.08-7.10]，p=0.034），且在多变量调整后仍然具有统计学意义（OR2.66[95%CI1.00-7.07]，p=0.049）。PCA 受累在单变量和多变量分析中均与后部出血相关。地形分析显示，与阳性脉络膜吻合相关的出血部位与脉络膜动脉的解剖分布，包括丘脑和心房壁之间存在良好的对应关系。
脉络膜吻合和 PCA 受累是烟雾病后部出血的特征。脉络膜吻合可能被认为是再出血风险高的后部出血的潜在来源。
