Departments of1Neurosurgery.
2Radiology, and.
J Neurosurg. 2023 Aug 25;140(2):441-449. doi: 10.3171/2023.6.JNS231017. Print 2024 Feb 1.
Choroidal anastomosis (ChA) has been implicated as the main indicator of an increased hemorrhagic risk in adult moyamoya disease. In this retrospective study, the authors aimed to identify the potential risk factors that can influence the rupture of ChA.
The authors evaluated the clinical and radiological data on brain hemispheres positive for ChA from September 2019 to March 2023. The rupture status of the ChA was determined using previously described methods. Two independent raters quantitatively investigated the lumen diameter (LD) and lumen area (LA) of the ChA using high-resolution vessel wall imaging (VWI). Multivariate logistic regression analysis was conducted to identify the risk factors for ruptured ChA.
Ruptured and unruptured ChAs were identified in 16 and 60 hemispheres, respectively. Univariate analysis showed that the mean values of the LD (1.251 ± 0.241 vs 0.967 ± 0.214 mm, p < 0.001) and LA (1.607 ± 0.445 vs 0.945 ± 0.372 mm2, p < 0.001) of ChAs were significantly greater in the ruptured group than in the unruptured group. A periventricular anastomosis (PA) score of 1, indicating the angiographic presence of ChA alone, was more prevalent in the ruptured group than in the unruptured group (43.8% vs 11.7%, p = 0.003). Multivariate analysis demonstrated that a larger LA of the ChA (OR 37.01, 95% CI 5.787-236.7, p < 0.001) and PA score 1 (OR 6.661, 95% CI 1.260-35.21, p = 0.026) were independently associated with ruptured ChA hemispheres. Receiver operating characteristic curve analysis revealed that the optimal cutoff point for the LA was 1.285 mm2 (sensitivity 81.3%, specificity 86.7%).
A larger LA (> 1.285 mm2) of the ChA and the angiographic presence of ChA alone are independent risk factors for a ruptured ChA. Revascularization surgery for the prevention of future hemorrhage may be indicated for hemispheres with a high-risk unruptured ChA. These characteristics may help to determine treatment strategies for patients with an unruptured ChA.
脉络膜吻合（ChA）被认为是成人烟雾病出血风险增加的主要指标。在这项回顾性研究中，作者旨在确定可能影响 ChA 破裂的潜在危险因素。
作者评估了 2019 年 9 月至 2023 年 3 月间脑半球阳性 ChA 的临床和影像学数据。使用先前描述的方法确定 ChA 的破裂状态。两位独立的评估者使用高分辨率血管壁成像（VWI）定量研究 ChA 的管腔直径（LD）和管腔面积（LA）。采用多变量逻辑回归分析确定 ChA 破裂的危险因素。
分别在 16 个和 60 个脑半球中发现了破裂和未破裂的 ChA。单因素分析显示，破裂组 ChA 的 LD（1.251±0.241 比 0.967±0.214mm，p<0.001）和 LA（1.607±0.445 比 0.945±0.372mm2，p<0.001）的平均值明显大于未破裂组。破裂组中单独存在 ChA 的血管造影表现的脑室内吻合（PA）评分 1 更为常见（43.8%比 11.7%，p=0.003）。多变量分析表明，ChA 的更大 LA（OR 37.01，95%CI 5.787-236.7，p<0.001）和 PA 评分 1（OR 6.661，95%CI 1.260-35.21，p=0.026）是与破裂 ChA 半球独立相关的因素。受试者工作特征曲线分析显示，LA 的最佳截断点为 1.285mm2（敏感性 81.3%，特异性 86.7%）。
ChA 的更大 LA（>1.285mm2）和单独存在 ChA 的血管造影表现是 ChA 破裂的独立危险因素。对于高危未破裂 ChA 的半球，可能需要进行血运重建手术以预防未来的出血。这些特征可能有助于确定未破裂 ChA 患者的治疗策略。
