title: Sonographic findings associated with stenosis progression and vascular complications in moyamoya disease.
abstract: OBJECT The progression of arterial stenosis in patients with moyamoya disease (MMD) has variable courses and an unclear mechanism. The authors hypothesized that elevated wall shear stress (WSS) at the terminal internal carotid artery (ICA) and proximal middle cerebral artery (MCA) may facilitate MMD progression. They indirectly evaluated the relative magnitude of WSS (WSS value [WSSV]) with MR angiography (MRA) and transcranial Doppler to determine its predictive value for stenosis progression (SP) and the development of vascular complications. METHODS Thirty-one medically treated patients (58 hemispheres and 95 nonoccluded vessels) were analyzed with serial MRA (median follow-up 23 months). The parameters studied were SP, SP rates (SPRs) for individual ICAs/MCAs, and their mean values from the ipsilateral hemispheres as mean SP (MSP) and MSP rates (MSPRs). Significant progression was defined as decrements of ≥ 20% for SP and MSP and ≥ 10%/year for SPR and MSPR. The development of vascular complications in relevant hemispheres was also recorded. The WSSV (dyne/cm(2)) was defined as the shear rate multiplied by blood viscosity. RESULTS After adjusting the initial stenosis degree and MRA stage of MMD, an SP of ≥ 20% and an SPR of ≥ 10%/year were associated with the highest-quartile WSSVs for all individual vessels and for MCAs and ICAs separately. For each hemisphere, an MSP of ≥ 20% and an MSPR of ≥ 10%/year were associated with the highest-quartile mean WSSVs. Furthermore, significant SP was highly correlated with vascular complications, and the highest-quartile mean WSSV was independently associated with vascular complications in relevant hemispheres. CONCLUSIONS An elevated WSSV is an independent predictor for SP and vascular complications in nonoccluded MMD.
authors.affiliation: Department of Neurology, Seoul National University Hospital;
authors.forename: Woo-Jin
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Department of Neurology, Seoul National University Hospital;|Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University;
authors.forename: Keun-Hwa
authors.initials: KH
authors.lastname: Jung
authors.affiliation: Department of Neurology, Seoul National University Hospital;
authors.forename: Keon-Joo
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Department of Neurology, Chung-Ang University Hospital, Seoul; and.
authors.forename: Jeong-Min
authors.initials: JM
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul National University Hospital;|Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University;
authors.forename: Soon-Tae
authors.initials: ST
authors.lastname: Lee
authors.affiliation: Department of Neurology, Seoul National University Hospital;|Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University;
authors.forename: Kon
authors.initials: K
authors.lastname: Chu
authors.affiliation: Department of Neurology, Seoul National University Hospital;|Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University;
authors.forename: Sang Kun
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Neurology, Seoul National University Hospital;|Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea.
authors.forename: Jae-Kyu
authors.initials: JK
authors.lastname: Roh
mesh_terms: D003251:Constriction, Pathologic; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography; D017585:Ultrasonography, Doppler, Transcranial; D014652:Vascular Diseases / Q000209:etiology
keywords: BV = blood viscosity; DR = diameter ratio; ICA = internal carotid artery; IQR = interquartile range; MCA = middle cerebral artery; MFV = mean flow velocity; MMD = moyamoya disease; MMP = matrix metalloproteinase; MRA = MR angiography; MSP = mean stenosis progression; MSPR = MSP rate; MWSSV = mean wall shear stress value; ROC = receiver operating characteristic; SD = stenosis degree; SP = stenosis progression; SPR = SP rate; SR = shear rate; TCD = transcranial Doppler; TIMP = tissue inhibitor of metalloproteinase; TOF = time-of-flight; WSS = wall shear stress; WSSV = WSS value; angiography; moyamoya disease; progression; transcranial Doppler; vascular disorders; vascular remodeling; wall shear stress