| Objective:To investigate the collateral circulation pattern of adult Moyamoya disease and the degree of intracranial artery stenosis,and analyse the influence of the formation of collateral circulation and the stenosis of the main arteries in intracranial patients with cerebral infarction in adult ischemic Moyamoya disease.Methods:Retrospective analysis of the clinical and imaging data of 81 cases in the first affiliated Hospital of Nanchang University for the diagnosis of ischemic type Moyamoya disease during February 2012-April 2017,according to preoperative craniocerebral MRI results,the patients were statistically graded and counted on the stenosis of intracranial arteries before operation according to the results of DSA examination,and classified and counted the common cranial medial branches circulation.According to statistical results,the independent risk factors of cerebral infarction in different parts were selected by logistic regression analysis Results:In 81 patients,23 patients underwent bilateral cerebral infarction and 42 patients underwent unilateral cerebral infarction,The anterior watershed(AWS)cerebral infarction is most common,followed by the posterior watershed(PWS)and deep white matter Area(DWM).In 162 hemispheres,there were 120 cases of anterior cerebral artery stenosis(74.1%),which were most common in 0-grade stenosis and accounted for 78 cases(48.1%).A total of 116 cases were observed in the middle cerebral artery stenosis,the most common of which was 2-level stenosis and accounted for 59 cases(36.4%).Only 63 cases of the cerebral hemisphere were observed in the stenosis of the posterior artery.A total of 11 common collateral circulation were observed in this study.In multi-factor analysis,the degree of ACA stenosis [or 0.73(0.56-0.95),P=0.02],MCA narrow degree [0.62(0.45-0.87),P=0.01],the stenosis degree of PCA [or 0.77(0.59-0.99),P=0.04],the collateral circulation level of PCHA [or 0.63(0.44-0.89),P=0.01],ACOA-ACA collateral circulation level [or] 0.59(0.39-0.91),P=0.02,is significantly correlated with cerebral infarction in the hemisphere.Age [or 1.04(1.01-1.08),degree of P=0.02],ACA stenosis [or 0.65(0.50-0.86),P=0.01] is significantly correlated with the occurrence of cerebral infarction in the anterior watershed area.Degree of stenosis of MCA [or 0.60(0.43-0.86),P=0.01],collateral circulation of PCA-ACA [or 0.70(0.51-0.96),P=0.03],rank of smoke-like vessels [or 1.93(1.14-3.24),P=0.01] and whether there is a significant correlation between cerebral infarction in the posterior watershed area,the extent of MCA stenosis [or 0.54(0.39-0.75),P=0.01],The narrow degree of PCA [or 0.66(0.50-0.88),P=0.01],PCHA collateral circulation level [or 0.64(0.46-0.89),P=0.021],the collateral circulation level of MMA [or 0.56(0.33-0.96),P=0.04] is significantly associated with the occurrence of cerebral infarction in deep white matter.Conclusion:1.In the intracranial arteries that are predominantly involved in Moyamoya disease,the ACA is the most severely affected artery,the PCA is the lightest artery involved.2.The most common infarction area is the AWS area,followed by the PWS area and the DWM area.In this study,the 11 common collateral circulation was observed,the most common for PCA-MCA,PCA-ACA,PCHA and OA,followed by high to low frequencies from PCOA,ACHA,ACA-MCA,MMA,MCA-ACA,ACOA-ACA,ACOA-MCA.3.ACA,MCA,PCA stenosis degree,PCHA,ACOA-ACA collateral circulation rank is the independent risk factor of cerebral infarction in hemisphere.the degree of ACA stenosis and MCA-ACA collateral circulation is the independent risk factor of cerebral infarction in the anterior watershed area.The narrow degree of MCA,the lateral circulation level of PCA-ACA,the rank of smoke-like vessels is the independent risk factor of cerebral infarction occurring in the watershed area,MCA,PCA’s narrow degree,PCHA and MMA collateral circulation rank are independent risk factors for cerebral infarction in deep white matter area. |
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