title: Clinical Significance of the Champagne Bottle Neck Sign in the Extracranial Carotid Arteries of Patients with Moyamoya Disease.
abstract: OBJECTIVE
  The champagne bottle neck sign represents a rapid reduction in the extracranial ICA diameters and is a characteristic feature of Moyamoya disease. However, the clinical significance of the champagne bottle neck sign is unclear. We investigated the relationship between the champagne bottle neck sign and the clinical and hemodynamic stages of Moyamoya disease.
  
  
  METHODS
  We analyzed 14 patients with Moyamoya disease before revascularization (5 men, 9 women; age, 43.2 ± 19.3 years). The ratio of the extracranial ICA and common carotid artery diameters was determined using carotid ultrasonography or cerebral angiography; a ratio of < 0.5 was considered champagne bottle neck sign-positive. The clinical disease stage was determined using the Suzuki angiographic grading system. CBF and cerebral vasoreactivity also were measured.
  
  
  RESULTS
  The ICA/common carotid artery ratio (expressed as median [interquartile range]) decreased as the clinical stage advanced (stages I-II, 0.71 [0.60-0.77]; stages III-IV, 0.49 [0.45-0.57]; stages V-VI, 0.38 [0.34-0.47];P< .001). Lower ICA/common carotid artery ratio tended to occur in symptomatic versus asymptomatic arteries (0.47 [0.40-0.53] versus 0.57 [0.40-0.66], respectively;P= .06). Although the ICA/common carotid artery ratio was not related to cerebral perfusion, it decreased as cerebral vasoreactivity decreased (P< .01). All champagne bottle neck sign-positive arteries were classified as Suzuki stage ≥III, 73% were symptomatic, and 89% exhibited reduced cerebral vasoreactivity. In contrast, all champagne bottle neck sign-negative arteries were Suzuki stage ≤III, 67% were asymptomatic, and all showed preserved cerebral vasoreactivity.
  
  
  CONCLUSIONS
  The champagne bottle neck sign was related to advanced clinical stage, clinical symptoms, and impaired cerebral vasoreactivity. Thus, detection of the champagne bottle neck sign might be useful in determining the clinical and hemodynamic stages of Moyamoya disease.
authors.affiliation: From the Departments of Cerebrovascular Disease (C.Y., S.A., Y.K.) akaike_komachi@yahoo.co.jp.
authors.forename: C
authors.identifier: http://orcid.org/0000-0001-6638-9280
authors.initials: C
authors.lastname: Yasuda
authors.affiliation: From the Departments of Cerebrovascular Disease (C.Y., S.A., Y.K.).
authors.forename: S
authors.identifier: http://orcid.org/0000-0003-1969-2564
authors.initials: S
authors.lastname: Arakawa
authors.affiliation: Neurosurgery (T.Shimogawa, T.Sayama, S.H., T.M.), Japan Labour Health and Welfare Organization, Kyushu Rosai Hospital, Kitakyushu, Japan.
authors.forename: T
authors.identifier: http://orcid.org/0000-0002-1116-7194
authors.initials: T
authors.lastname: Shimogawa
authors.affiliation: From the Departments of Cerebrovascular Disease (C.Y., S.A., Y.K.).
authors.forename: Y
authors.identifier: http://orcid.org/0000-0003-3526-1406
authors.initials: Y
authors.lastname: Kanazawa
authors.affiliation: Neurosurgery (T.Shimogawa, T.Sayama, S.H., T.M.), Japan Labour Health and Welfare Organization, Kyushu Rosai Hospital, Kitakyushu, Japan.
authors.forename: T
authors.identifier: http://orcid.org/0000-0001-9885-7501
authors.initials: T
authors.lastname: Sayama
authors.affiliation: Neurosurgery (T.Shimogawa, T.Sayama, S.H., T.M.), Japan Labour Health and Welfare Organization, Kyushu Rosai Hospital, Kitakyushu, Japan.
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-8864-0728
authors.initials: S
authors.lastname: Haga
authors.affiliation: Neurosurgery (T.Shimogawa, T.Sayama, S.H., T.M.), Japan Labour Health and Welfare Organization, Kyushu Rosai Hospital, Kitakyushu, Japan.
authors.forename: T
authors.identifier: http://orcid.org/0000-0003-2114-2756
authors.initials: T
authors.lastname: Morioka