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Original research
Long-term outcomes of moyamoya disease versus atherosclerosis-associated moyamoya vasculopathy using high-resolution MR vessel wall imaging
  1. Mingming Lu1,2,
  2. Hongtao Zhang3,
  3. Shitong Liu3,
  4. Dongqing Liu3,
  5. Peng Peng1,
  6. Fangbin Hao4,
  7. Fei Yuan1,
  8. Yuan Liu3,
  9. Fugeng Sheng3,
  10. Lichen Zhang3,
  11. Xihai Zhao5,
  12. Yao He2,
  13. Cong Han4,
  14. Jianming Cai3
  1. 1Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
  2. 2Institute of Geriatrics, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
  3. 3Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
  4. 4Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
  5. 5Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
  1. Correspondence to Dr Jianming Cai, Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China; beili12345{at}sina.cn; Dr Cong Han, Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China; hc82225{at}126.com; Dr Yao He, Institute of Geriatrics, The Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China; yhe301{at}x263.net

Abstract

Objectives We aimed to compare the long-term outcomes and surgical benefits between moyamoya disease (MMD) and atherosclerosis-associated moyamoya vasculopathy (AS-MMV) using high-resolution MRI (HRMRI).

Methods MMV patients were retrospectively included and divided into the MMD and AS-MMV groups according to vessel wall features on HRMRI. Kaplan-Meier survival and Cox regression were performed to compare the incidence of cerebrovascular events and prognosis of encephaloduroarteriosynangiosis (EDAS) treatment between MMD and AS-MMV.

Results Of the 1173 patients (mean age: 42.4±11.0 years; male: 51.0%) included in the study, 881 were classified into the MMD group and 292 into the AS-MMV group. During the average follow-up of 46.0±24.7 months, the incidence of cerebrovascular events in the MMD group was higher compared with that in the AS-MMV group before (13.7% vs 7.2%; HR 1.86; 95% CI 1.17 to 2.96; p=0.008) and after propensity score matching (6.1% vs 7.3%; HR 2.24; 95% CI 1.34 to 3.76; p=0.002). Additionally, patients treated with EDAS had a lower incidence of events than those not treated with EDAS, regardless of whether they were in the MMD (HR 0.65; 95% CI 0.42 to 0.97; p=0.043) or AS-MMV group (HR 0.49; 95% CI 0.51 to 0.98; p=0.048).

Conclusions Patients with MMD had a higher risk of ischaemic stroke than those with AS-MMV, and patients with both MMD and AS-MMV could benefit from EDAS. Our findings suggest that HRMRI could be used to identify those who are at a higher risk of future cerebrovascular events.

  • STROKE
  • MRI
  • VASCULAR SURGERY

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • ML, HZ and SL are joint first authors.

  • Contributors ML, CH and JC contributed to the conception and design of the study. ML, HZ, SL, DL, FH, YL, FS and LZ contributed to the acquisition of data. ML, HZ and SL contributed to the drafting/revision of the manuscript. PP, FY and XZ contributed to analysis of data. CH and JC are guarantors for the overall contents.

  • Funding This study was supported by the grants of National Natural Science Foundation of China (82001774), Tianjin Science and Technology Project (TJWJ2021MS043), Beijing National Science Foundation (7212100).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.