1. Worse outcome in hemorrhagic moyamoya disease of anterior circulation type compared to posterior circulation type.
- Author
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Hirayama A, Yonemochi T, Sunaga A, Shigematsu H, and Sorimachi T
- Subjects
- Humans, Female, Male, Retrospective Studies, Middle Aged, Adult, Time Factors, Risk Factors, Prevalence, Prognosis, Disability Evaluation, Aged, Risk Assessment, Anterior Cerebral Artery diagnostic imaging, Anterior Cerebral Artery physiopathology, Posterior Cerebral Artery diagnostic imaging, Posterior Cerebral Artery physiopathology, Functional Status, Young Adult, Moyamoya Disease diagnostic imaging, Moyamoya Disease complications, Moyamoya Disease physiopathology, Cerebral Angiography, Cerebrovascular Circulation, Computed Tomography Angiography, Cerebral Hemorrhage diagnostic imaging, Cerebral Hemorrhage etiology
- Abstract
Objective: Despite the known poor outcomes of patients with hemorrhagic moyamoya disease (MMD), previous studies have not explored the entire population of hemorrhagic MMD, often excluding severely impaired patients due to the lack of imaging studies demonstrating cerebral angioarchitecture. Herein, we investigate the prevalence, location of intracerebral hematoma (ICH), and outcomes in patients with hemorrhagic MMD, including severely impaired individuals who underwent emergency computed tomography (CT) angiography (CTA) to identify secondary ICHs., Methods: We conducted a retrospective analysis of 2092 patients admitted to our hospital within 3 days of ICH onset from January 2010 to December 2022. CTA was performed for all patients with ICH, principally., Results: CTA was performed in 1645 (78.6%) patients. We diagnosed MMD in 40 patients (2.5%), making it the third leading cause of secondary ICH. Twenty patients had anterior-type hematomas, while the remaining twenty had posterior-type hematomas. At 90 days after onset, 19 patients (95%) with anterior-type hematomas had unfavorable outcomes (modified Rankin scale [mRS] scores of 3-6), compared to 11 patients (55%) with posterior-type hematomas. The number of unfavorable outcomes was significantly higher in the anterior-type group compared to the posterior-type group (p = 0.008)., Conclusion: This comprehensive study highlights that the majority of MMD cases with ICH result in unfavorable outcomes, especially when the ICH is located in the anterior circulation. While recent studies have focused on preventing bleeding from choroidal anastomosis in the posterior circulation, overall outcome improvement of hemorrhagic MMD necessitates a greater emphasis on addressing anterior circulation ICHs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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