Isolated anterior cerebral artery occlusion:an atypical form of moyamoya disease  

作　　者：Si-Meng Liu Gan Gao Fang-bin Hao Shi-tong Liu Ri-miao Yang Hou-di Zhang Min-Jie Wang Zheng-xing Zou Dan Yu Qian Zhang Qing-Bao Guo Xiao-Peng Wang He-guan Fu Jing-Jie Li Cong Han Lian Duan 

机构地区：[1]Department of Neurosurgery,the First Medical Center of Chinese PLA General Hospital,Beijing,China [2]Department of Neurosurgery,the Fifth Medical Center of Chinese PLA General Hospital,Beijing,China [3]Medical School of Chinese PLA,Beijing,China

出　　处：《Stroke & Vascular Neurology》2024年第6期660-670,共11页卒中与血管神经病学(英文)

基　　金：National Natural Science Foundation of China(grant No 82171280 and 82172021).

摘　　要：Background The relationship between anterior cerebral artery(ACA)occlusion and moyamoya disease(MMD)has rarely been studied.In this study,we focused on a special type of MMD:isolated ACA-occlusive MMD.We investigated clinical attributes,genotypes and progression risk factors in patients with ACA-occlusive MMD,providing initial insights into the relationship between ACA occlusion and MMD.Methods We retrospectively analysed digital subtraction angiography(DSA)from 2486 patients and diagnosed 139 patients with ACA-occlusive MMD.RNF213 p.R4810K(rs112735431)mutation analysis was performed.Patients were categorised into progression and non-progression groups based on whether they progressed to typical MMD.Differences in clinical characteristics,neuropsychological assessment,radiological findings and genotypes were evaluated.Logistic regression analyses identified risk factors for ACA-occlusive MMD progression.Results The median age of patients with ACA-occlusive MMD was 36 years,and the primary symptom was transient ischaemic attack(TIA).72.3%of ACA-occlusive MMD patients had cognitive decline.Of 116 patients who underwent RNF213 gene mutation analysis,90 patients(77.6%)carried the RNF213 p.R4810K GG allele and 26(22.4%)carried the GA allele.Of 102 patients with follow-up DSA data,40 patients(39.2%)progressed.Kaplan-Meier curve estimates indicated a higher incidence of ischaemic stroke in the progression group during follow-up(p=0.035).Younger age(p=0.041),RNF213 p.R4810K GA genotype(p=0.037)and poor collateral compensation from the middle cerebral artery(MCA)to ACA(p<0.001)were risk factors of ACA-occlusive MMD progression to typical MMD.Conclusions Cognitive decline and TIA might be the main manifestations of ACA-occlusive MMD.Isolated ACA occlusion may be an early signal of MMD.The initial lesion site of MMD is not strictly confined to the terminal portion of the internal carotid artery.Younger patients,patients with RNF213 p.R4810K GA genotype or those with inadequate MCA-to-ACA compensation are more likely to deve

关 键 词：OCCLUSION CEREBRAL LIKELY 

分 类 号：R743.31[医药卫生—神经病学与精神病学]