Wang Jian, Chen Gong, Yang Yongbo, Zhang Bing, Jia Zhongzhi, Gu Peiyuan, Wei Dong, Ji Jing, Hu Weixing, Zhao Xihai
Department of Neurosurgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China; Department of Neurosurgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
World Neurosurg. 2018 Oct;118:e18-e24. doi: 10.1016/j.wneu.2018.06.043. Epub 2018 Jun 15.
To assess association between champagne bottle neck sign (CBNS) in carotid artery and intracranial hemorrhage in patients with moyamoya disease (MMD).
This retrospective study included 76 consecutive patients with MMD without definite risk factors associated with intracranial hemorrhage who underwent preoperative angiography from January 2016 to December 2017. CBNS was defined as luminal diameter ratio of internal carotid artery/common carotid artery ≤0.5 on angiography. The right and left cerebral hemisphere in each patient was separately identified as hemorrhagic and nonhemorrhagic. Association between CBNS and intracranial hemorrhage was analyzed.
Of 76 patients with MMD, intracranial hemorrhage was found in 44 of 152 (28.9%) hemispheres, and 6.8% (3/44) had multiple events. Comparing carotid arteries without intracranial hemorrhage in ipsilateral hemispheres, patients with intracranial hemorrhage in the ipsilateral hemisphere had significantly smaller luminal diameter ratio of internal carotid artery/common carotid artery (0.49 ± 0.11 vs. 0.55 ± 0.12, P < 0.01) and higher prevalence of CBNS (63.7% vs. 41.7%, P = 0.01). Comparing hemispheres with intracranial hemorrhage, patients with ipsilateral carotid artery CBNS had significantly higher prevalence of hemorrhage in posterior territories than patients without CBNS (57.1% vs. 23.1%, P = 0.05). Logistic regression revealed that CBNS was significantly associated with ipsilateral intracranial hemorrhage before (odds ratio = 2.45; 95% confidence interval, 1.19-5.05; P = 0.02) and after (odds ratio = 3.43; 95% confidence interval, 1.50-7.87; P < 0.01) adjusting for female sex, lenticulostriate anastomosis, and choroidal anastomosis.
CBNS is significantly associated with intracranial hemorrhage in the ipsilateral hemisphere in patients with MMD, particularly intracranial hemorrhage in posterior territories.
评估烟雾病（MMD）患者颈动脉的香槟瓶颈征（CBNS）与颅内出血之间的关联。
这项回顾性研究纳入了2016年1月至2017年12月期间连续76例无明确颅内出血相关危险因素且接受术前血管造影的MMD患者。CBNS定义为血管造影时颈内动脉/颈总动脉的管腔直径比≤0.5。将每位患者的左右脑半球分别确定为出血性和非出血性。分析CBNS与颅内出血之间的关联。
在76例MMD患者中，152个半球中有44个（28.9%）发现颅内出血，6.8%（3/44）有多次出血事件。与同侧半球无颅内出血的颈动脉相比，同侧半球有颅内出血的患者颈内动脉/颈总动脉的管腔直径比明显更小（0.49±0.11对0.55±0.12，P<0.01），CBNS的患病率更高（63.7%对41.7%，P=0.01）。与有颅内出血的半球相比，同侧颈动脉有CBNS的患者后循环区域出血的患病率明显高于无CBNS的患者（57.1%对23.1%，P=0.05）。逻辑回归显示，在调整性别、豆纹动脉吻合和脉络膜吻合后，CBNS与同侧颅内出血显著相关（比值比=2.45；95%置信区间，1.19-5.05；P=0.02），调整后（比值比=3.43；95%置信区间，1.50-7.87；P<0.01）。
CBNS与MMD患者同侧半球的颅内出血显著相关，尤其是后循环区域的颅内出血。
