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Roche F, Celle S, Perek N, Guillot P. The role of obstructive sleep apnea/hypopnea for leukoaraiosis and its cognitive consequences: a discussion still open! Sleep 2025; 48:zsae283. [PMID: 39656770 PMCID: PMC11807890 DOI: 10.1093/sleep/zsae283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Indexed: 12/17/2024] Open
Affiliation(s)
- Frédéric Roche
- Physiology Laboratory, Physiology Department, VISAS Sleep Center, University Hospital, Saint Etienne, France
- Jacques Lisfranc Faculty of Medicine, Inserm Sainbiose U1059 SAINBIOSE, DVH, Jean Monnet University, Ecole des Mines, Saint Etienne, France
| | - Sébastien Celle
- Physiology Laboratory, Physiology Department, VISAS Sleep Center, University Hospital, Saint Etienne, France
- Jacques Lisfranc Faculty of Medicine, Inserm Sainbiose U1059 SAINBIOSE, DVH, Jean Monnet University, Ecole des Mines, Saint Etienne, France
| | - Nathalie Perek
- Jacques Lisfranc Faculty of Medicine, Inserm Sainbiose U1059 SAINBIOSE, DVH, Jean Monnet University, Ecole des Mines, Saint Etienne, France
| | - Pauline Guillot
- Jacques Lisfranc Faculty of Medicine, Inserm Sainbiose U1059 SAINBIOSE, DVH, Jean Monnet University, Ecole des Mines, Saint Etienne, France
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Ryška P, Lojík M, Habalová J, Kajzrová C, Česák T, Vítková E, Bartoš M, Bělobrádek Z, Krajina A. Endovascular Therapy of Ruptured Aneurysms on Moyamoya Collateral Vessels: Two Cases. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1499. [PMID: 39336542 PMCID: PMC11433880 DOI: 10.3390/medicina60091499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 09/11/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024]
Abstract
Background: Using two case reports of adult women with moyamoya disease presenting with intracranial hemorrhage from ruptured aneurysms on moyamoya collateral vessels, we aim to demonstrate the potential for effective endovascular treatment navigated by CT angiography, digital subtraction angiography, and flat panel CT. Case 1 Presentation: A 45-year-old female patient with sudden onset of headache, followed by somnolency. CT scan showed a four-ventricle hematocephalus caused by a 27 × 31 × 17 mm hematoma located in the left basal ganglia. Angiography revealed a 3 mm aneurysm on hypertrophic lenticulostriate artery bridging the M1 occlusion. Selective catheterization and distal embolisation with acrylic glue was done. Case 2 Presentation: A 47-year-old woman was admitted for a sudden onset of severe headache, CT scan showed four-ventricle hematocephalus. A 4 mm aneurysm on the collateral vessel-anterior chorioidal artery bridging the closure of the terminal segment of the internal carotid artery was diagnosed as the source of bleeding. Selective catheterization and distal embolisation with acrylic glue was done. Conclusions: Selective embolisation of ruptured aneurysms on moya moya collaterals is a simple, effective, and safe procedure when relevant microcatheters are used with imaging software navigation such as 3D DSA, 3D road map and flat-panel CT.
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Affiliation(s)
- Pavel Ryška
- Department of Radiology, University Hospital, 50005 Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University, 50003 Hradec Kralove, Czech Republic
| | - Miroslav Lojík
- Department of Radiology, University Hospital, 50005 Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University, 50003 Hradec Kralove, Czech Republic
| | - Jiřina Habalová
- Department of Neurosurgery, University Hospital, Faculty of Medicine, Charles University, 50005 Hradec Kralove, Czech Republic
| | - Carmen Kajzrová
- Department of Neurosurgery, University Hospital, Faculty of Medicine, Charles University, 50005 Hradec Kralove, Czech Republic
| | - Tomáš Česák
- Department of Neurosurgery, University Hospital, Faculty of Medicine, Charles University, 50005 Hradec Kralove, Czech Republic
| | - Eva Vítková
- Department of Neurology, University Hospital, Faculty of Medicine, Charles University, 50005 Hradec Kralove, Czech Republic
| | - Michael Bartoš
- Department of Neurosurgery, University Hospital, Faculty of Medicine, Charles University, 50005 Hradec Kralove, Czech Republic
| | - Zdeněk Bělobrádek
- Department of Radiology, University Hospital, 50005 Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University, 50003 Hradec Kralove, Czech Republic
| | - Antonín Krajina
- Department of Radiology, University Hospital, 50005 Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University, 50003 Hradec Kralove, Czech Republic
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Haas P, Wiggenhauser LM, Tellermann J, Hurth H, Feucht D, Tatagiba M, Khan N, Roder C. Vascular risk profile and changes of arterial hypertension after surgical revascularization in adult Moyamoya patients. Sci Rep 2024; 14:12364. [PMID: 38811635 PMCID: PMC11137083 DOI: 10.1038/s41598-024-61966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/13/2024] [Indexed: 05/31/2024] Open
Abstract
Moyamoya disease (MMD) is a rare stenoocclusive cerebral vasculopathy often treated by neurosurgical revascularization using extracranial-intracranial bypasses to prevent ischemic or hemorrhagic events. Little is known about the vascular risk profile of adult MMD patients compared to the general population. We therefore analyzed 133 adult MMD patients and compared them with data from more than 22,000 patients from the German Health Update database. Patients with MMD showed an age- and sex-adjusted increased prevalence of arterial hypertension, especially in women between 30 and 44 years and in patients of both sexes between 45 and 64 years. Diabetes mellitus was diagnosed significantly more frequently in MMD patients with increasing age, whereas the vascular risk profile in terms of obesity, nicotine and alcohol consumption was similar to that of the general population. Antihypertensive medication was changed one year after surgical revascularization in 67.5% of patients with a tendency towards dose reduction in 43.2% of all patients. After revascularization, physicians need to be aware of a high likelihood of changes in arterial hypertension and should adjust all other modifiable systemic vascular risk factors to achieve the best treatment possible.
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Affiliation(s)
- Patrick Haas
- Department of Neurosurgery and Moyamoya Center, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Lucas Moritz Wiggenhauser
- Department of Neurosurgery and Moyamoya Center, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Jonas Tellermann
- Department of Neurosurgery and Moyamoya Center, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Helene Hurth
- Department of Neurosurgery and Moyamoya Center, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Daniel Feucht
- Department of Neurosurgery and Moyamoya Center, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery and Moyamoya Center, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Nadia Khan
- Department of Neurosurgery and Moyamoya Center, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
- Moyamoya Center, University Children's Hospital of Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Constantin Roder
- Department of Neurosurgery and Moyamoya Center, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
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Liu W, Huang K, Zhang J, Zhou D, Chen J. Clinical Features and Risk Factors of Postoperative Stroke in Adult Moyamoya Disease. Brain Sci 2023; 13:1696. [PMID: 38137144 PMCID: PMC10741386 DOI: 10.3390/brainsci13121696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND AND PURPOSE The clinical features of and risk factors for postoperative stroke after surgical revascularization in adult moyamoya disease (MMD) have not been fully elucidated. To this end, the baseline clinical features were hereby described, and the risk factors for postoperative stroke were determined. METHODS Data of 4078 MMD inpatients were collected retrospectively across all secondary- and higher-level hospitals of Hubei Province from January 2019 to December 2020. In accordance with inclusion and exclusion criteria, 559 adult MMD inpatients were finally enrolled. The associated characteristics and potential risk factors were analyzed, and the Kaplan-Meier risk of stroke was also calculated. RESULTS The patients consisted of 286 females and 273 males, with a mean age of 49.1 ± 10.0 years, all of whom had at least 1 year of follow-up (median 25.1 months). There were 356 cases of preoperative ischemic symptoms and 203 cases of preoperative hemorrhage symptoms. Indirect, direct, and combined revascularization were conducted on 97, 105 and 357 patients, respectively. Among these patients, 17 had postoperative hemorrhagic stroke (PHS), and 43 had postoperative ischemic stroke (PIS). A comparison between PHS/PIS group and control group (patients without postoperative stroke events) showed that preoperative hemorrhage was significantly associated with PHS (p = 0.003), while hypertension (p = 0.003), diabetes mellitus (p = 0.003) and modified Rankin scale (mRS) (p = 0.034) at admission were associated with a higher rate of PIS. Furthermore, preoperative hemorrhagic stroke was identified as a risk factor for PHS (odds ratio [OR], 4.229 [95% CI, 1.244-14.376]; p = 0.021), while hypertension (odds ratio [OR], 0.424 [95% CI, 0.210-0.855]; p = 0.017), diabetes mellitus (odds ratio [OR], 0.368 [95% CI, 0.163-0.827]; p = 0.016) and admission mRS (odds ratio [OR], 2.301 [95% CI, 1.157-4.575]; p = 0.017) were found to be risk factors for PIS. CONCLUSIONS The age distribution of adult MMD patients with revascularization was predominantly concentrated within the range from 46 to 55 years. Preoperative hemorrhage events were considered the risk factor for PHS. Hypertension, diabetes and admission mRS were correlated with PIS, and were also the risk factors for PIS. These results indicated the possible contribution of enhancing systematic disease management to the prevention of postoperative cerebrovascular accidents.
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Affiliation(s)
- Wen Liu
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Donghu Road 169, Wuhan 430071, China; (W.L.); (K.H.); (J.Z.)
- Neuroepigenetic Research Lab, Medical Research Institute, Wuhan University, Donghu Road 115, Wuhan 430071, China
| | - Kaixin Huang
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Donghu Road 169, Wuhan 430071, China; (W.L.); (K.H.); (J.Z.)
- Neuroepigenetic Research Lab, Medical Research Institute, Wuhan University, Donghu Road 115, Wuhan 430071, China
| | - Jianjian Zhang
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Donghu Road 169, Wuhan 430071, China; (W.L.); (K.H.); (J.Z.)
- Neuroepigenetic Research Lab, Medical Research Institute, Wuhan University, Donghu Road 115, Wuhan 430071, China
| | - Da Zhou
- Center for Health Information and Statistics of Hubei, Wuhan 430071, China;
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Donghu Road 169, Wuhan 430071, China; (W.L.); (K.H.); (J.Z.)
- Neuroepigenetic Research Lab, Medical Research Institute, Wuhan University, Donghu Road 115, Wuhan 430071, China
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Lucia K, Acker G, Rubarth K, Beyaztas D, Vajkoczy P. The Development and Effect of Systemic Hypertension on Clinical and Radiological Outcome in Adult Moyamoya Angiopathy Following Revascularization Surgery: Experience of a Single European Institution. J Clin Med 2023; 12:4219. [PMID: 37445259 DOI: 10.3390/jcm12134219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/10/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Patients with Moyamoya Angiopathy (MMA) display structurally altered vessels with decreased cerebral autoregulatory capacity, so aggressive lowering of systemic hypertension may aggravate ischemic symptoms, whereas uncontrolled hypertension may promote hemorrhage. This study provides an in-depth analysis of the role of hypertension in adult MMA patients including long-term analysis of clinical and radiological development. In this single-center retrospective analysis of 137 adult MMA patients with 206 surgically treated hemispheres angiographic images, clinical/operative data were reviewed and scored. Univariate Cox-regression analysis was performed to evaluate hypertension as a predictor for negative angiographic and clinical outcomes following revascularization surgery. A total of 50% of patients were being treated for hypertension prior to the first surgery. Patients with and without hypertension did not differ in terms of age, gender, diagnosis, symptom onset or disease severity (Berlin and Suzuki Grades). Although hypertension did not statistically significantly affect postoperative collaterals, moyamoya vessels or STA-MCA bypass patency, patients with hypertension showed higher rates of bypass patency and better bypass filling compared to those without hypertension. No significant differences in adverse events were found in patients with and without systemic hypertension and the presence of systemic hypertension was not found to predict negative clinical or radiological outcomes. In conclusion, the rate of systemic hypertension in MMA patients appears to be higher than the general population; however, this is not associated with an increased risk of postoperative complications or negative angiographic development following revascularization procedures. Systemic hypertension may also positively influence the rate of bypass patency and filling following revascularization procedures.
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Affiliation(s)
- Kristin Lucia
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Neurosurgery, Goethe University Hospital Frankfurt Am Main, Schleusenweg 2-16, 60528 Frankfurt Am Main, Germany
| | - Güliz Acker
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Kerstin Rubarth
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Institute of Biometrics and Clinical Epidemiology Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Institute of Medical Informatics Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Defne Beyaztas
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
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