From the Department of Neurosurgery (J.W., Z.W.), The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China.
Departments of Neurosurgery (J.W., Y.Y., Q.L., Y.W., S.N., X.C.).
AJNR Am J Neuroradiol. 2019 Oct;40(10):1665-1671. doi: 10.3174/ajnr.A6208. Epub 2019 Sep 19.
Choroidal collateral anastomosis is associated with hemorrhage recurrence in patients with Moyamoya disease. However, the relationship between recurrent ipsilateral hemorrhage and choroidal collateral anastomosis subtypes (anterior choroidal artery anastomosis, lateral posterior choroidal artery anastomosis, and medial posterior choroidal artery anastomosis) is unclear. This study aimed to assess this potential association in adult patients with Moyamoya disease.
Patients angiographically diagnosed with Moyamoya disease who underwent conservative treatment between January 2008 and December 2018 were included in this retrospective study. Two readers assessed the angiographic images to identify choroidal collateral anastomosis subtypes, and Cox proportional hazard regression models were used to estimate the risk of recurrent hemorrhage associated with each subtype.
Thirty-nine patients (mean age = 45.2 years) were included in this study. During 52.4 ± 37.0 months of follow-up, recurrent ipsilateral hemorrhage occurred in 48.7% (19/39) of patients. Patients with recurrent hemorrhage had a higher prevalence of choroidal collateral (94.8% versus 60.0%; = .02) and lateral posterior choroidal artery (78.9% versus 25.0%; < .01) anastomoses than those without recurrent hemorrhage. Lateral posterior choroidal artery anastomosis was associated with recurrent hemorrhage before (hazard ratio = 6.66; 95% CI, 2.18-20.39; < .01) and after (hazard ratio = 5.78; 95% CI, 1.58-21.13; < .01) adjustments were made for age, sex, and other confounding factors.
Choroidal collateral anastomosis is responsible for most cases of recurrent hemorrhage in adult patients with Moyamoya disease; lateral posterior choroidal artery anastomosis is a significant risk factor for these recurrent events.
脉络膜侧支吻合与烟雾病患者的出血再发相关。然而，再发同侧出血与脉络膜侧支吻合亚型（前脉络膜动脉吻合、外侧后脉络膜动脉吻合和内侧后脉络膜动脉吻合）之间的关系尚不清楚。本研究旨在评估成人烟雾病患者中这种潜在的相关性。
本回顾性研究纳入了 2008 年 1 月至 2018 年 12 月期间经血管造影诊断为烟雾病并接受保守治疗的患者。两名读者评估了血管造影图像，以识别脉络膜侧支吻合亚型，使用 Cox 比例风险回归模型来估计每种亚型与再发性出血相关的风险。
本研究纳入了 39 例患者（平均年龄=45.2 岁）。在 52.4±37.0 个月的随访期间，48.7%（19/39）的患者发生了同侧再发性出血。有再发性出血的患者更常见脉络膜侧支（94.8%与 60.0%； =.02）和外侧后脉络膜动脉吻合（78.9%与 25.0%； <.01）。在调整了年龄、性别和其他混杂因素后，外侧后脉络膜动脉吻合与再发性出血相关（调整前的危险比=6.66；95%置信区间，2.18-20.39； <.01；调整后的危险比=5.78；95%置信区间，1.58-21.13； <.01）。
脉络膜侧支吻合是成人烟雾病患者再发性出血的主要原因；外侧后脉络膜动脉吻合是这些再发事件的显著危险因素。
