Abstract 2795: Early Impairment of Collateral flow from Posterior circulation is a Determinant of Stroke recurrence in Adult Moyamoya disease

Abstract

Early impairment of collateral flow from posterior circulation is a determinant of stroke recurrence in adult moyamoya disease Hyun Jin Noh,MD 1 , Suk Jae Kim,MD 1 , Jong Soo Kim 2 , Seung-Chyul Hong 2 , Keon Ha Kim 3 , Pyeong Jun 3 , Oh Young Bang 1 , Chin-Sang Chung 1 , Kwang Ho Lee 1 , Gyeong-Moon Kim, MD 11 Department of Neurology, 2 Neurosurgery, and 3 Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea BACKGROUND: Adult moyamoya disease (MMD) is a progressive arteriopathy with high recurrence rate of ischemic stroke. But factors associated with the symptom recurrence in adult MMD have not been evaluated. The purpose of present study is to evaluate determinants of recurrent ischemic stroke in symptomatic adult MMD. METHODS: In this retrospective cohort, symptomatic adult MMD patients who were not surgically treated at Samsung medical center were enrolled between 1998.03 - 2010.03. All patients underwent conventional angiography, brain MRI, and MR angiography. Clinical and neuroimaging variables were analyzed to identify risk factors associated with recurrent ischemic stroke. RESULTS: Among 38 patients enrolled, 15 patients (9 female, mean age 45.4±3.6 yrs) were identified as recurrent ischemic stroke and 23 patients (14 female, mean age 41.3±7.0 yrs) without. Mean follow-up duration was 56.3±6.2 months. Multivariable regression analysis revealed group with recurrent ischemic stroke had a more chance to have significant stenosis in posterior cerebral arteries (PCA) than those without recurrent ischemic stroke (OR 6.48, 95% Confidence Interval 1.48 -28.33, P=0.015). The sensitivity of PCA stenosis was 60 %, the specificity 78.2 %, the positive predict value 64.2 %, and the negative predict value 75 %. However, there was no difference between groups in terms of the angiographic grading score, vascular risk factors, laboratory findings and medications. CONCLUSION: Our findings suggest that early impairment of collateral flow from posterior circulation may contribute to the recurrent ischemic stroke in adult MMD.