title: Posterior cerebral artery involvement in moyamoya disease: initial infarction and angle between PCA and basilar artery.
abstract: OBJECTIVE
  Moyamoya disease (MMD) is a chronic cerebrovascular occlusive disease, and progressive involvement of the posterior cerebral artery (PCA) has been reported. However, majority of MMD articles are presenting classic anterior circulation related issues. This study investigates the preoperative factors related to the long-term outcome of posterior circulation in MMD.
  
  
  METHODS
  Retrospective review of 88 MMD patients (166 PCAs in either hemisphere) without symptomatic disease involvement of PCA at initial diagnosis was done. Data at initial diagnosis regarding age, presence of infarction, status of the PCA, type of posterior communicating artery, and the angle between PCA and basilar artery were reviewed. Progressive stenosis of PCA was evaluated by symptom or radiological imaging during follow up.
  
  
  RESULTS
  During an average follow up of 8.3 years, 29 out of 166 (18 %) evaluated PCAs showed progressive disease involvement. The average time of progression from the initial operation was 4.9 years, with the latest onset at 10.8 years. The patients who showed progressive stenosis of the PCA tended to be younger, present with infarction, have smaller angle between PCA and basilar artery, and have asymptomatic stenosis of the PCA at initial presentation. However, multivariate analysis confirmed only the presence of initial infarction and a smaller angle between PCA and basilar artery to be significantly associated with progressive stenosis of PCA.
  
  
  CONCLUSIONS
  Involvement of PCA in MMD may occur in a delayed fashion, years after the completion of revascularization of anterior circulation. Persistent long-term follow-up regarding the posterior circulation is recommended.
authors: Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors: Ji Yeoun
authors: JY
authors: Lee
authors: Seung-Ki
authors: SK
authors: Kim
authors: Jung-Eun
authors: JE
authors: Cheon
authors: Jung Won
authors: JW
authors: Choi
authors: Ji Hoon
authors: JH
authors: Phi
authors: In-One
authors: IO
authors: Kim
authors: Byung-Kyu
authors: BK
authors: Cho
authors: Kyu-Chang
authors: KC
authors: Wang
mesh_terms: D000293:Adolescent; D001488:Basilar Artery / Q000473:pathology*; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009072:Moyamoya Disease / Q000150:complications / Q000473:pathology*; D020769:Posterior Cerebral Artery / Q000473:pathology*; D012189:Retrospective Studies
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