| Moyamoya disease(MMD) is a kind of disorder characterized by chronic progressive stenosis or occlusion of the terminal portion of bilateral internal carotid arteries and the proximal portion of the anterior and/or middle cerebral arteries, and is accompanied by the formation of net-like collateral vessels, the “ moyamoya” vessels. The pathogenesis of moyamoya remains to be elucidated. According to the recent literature, about 1/3 patients are accompanied by the posterior circulation lesions. The cerebral digital subtraction angiography(DSA) shows that stenosis and occlusion also occurs in unilateral or bilateral posterior cerebral arteries, with moyamoya-like vessel angiogenesis at the base of posterior circulation lesions, when bilateral internal carotid arteries lesions already exist. With the disease progressing, the posterior cerebral arteries progressively disappear, and the moyamoya vessels are decreasing. Compared with the patients who have no posterior cerebral arteries lesions, the patients with posterior cerebral arteries lesions lose the compensative capacity fro m frontal circulation, which leads to transient ischemic attack(TIA) and cerebral infarction more severely, and at last result of posterior circulation lesions, including visual disturbance. The patients who have permanent visual disturbance caused by occipital lobe infarction is the major reason of the failure of the treatment. Our stud y is to determine the risk factors for the development of moyamoya disease complicated with posterior circulation lesion concomitant with occipital infarction so as to guide the clinical therapy and improve the outcome of this disease.Objective:According to the clinical reports obtained from patients with moyamoya disease and analyses of posterior circulation lesion, our study analyses the significant association between moyamoya disease complicated with posterior circulation lesion concomitant with occipital infarction and risk factors sex, age, Suzuki’s stage of left anterior circulation, Suzuki’s stage of left anterior circulation, Magikura stage of left posterior circulation and Magikura stage of right posterior circulation, diabetes, hypertension, hyperlipidemia, family history, smoking history, drinking history and determines the risk factors of the development of moyamoya disease complicated with posterior circulation lesion concomitant with occipital infarction.Method: From May 2003 to May 2013, 285 patients with moyamoya disease complicated with posterior circulation lesion were collected in neurosurgery department of The 307 th Hospital of Chinese People’s Liberation Army. A retrospective analysis was performed to these patients, among which 107 patients underwent posterior circulation lesions concomitant with ipsilateral occipital infarction. Spss19.0 software was used to analyze the statistic result and the logistic regression analysis was conducted to determine the significant association between twel ve risk factors sex, age, Suzuki’s stage of left anterior circulation, Suzuki’s stage of left anterior circulation, Magikura stage of left posterior circulation and Magikura stage of right posterior circulation, diabetes, hypertension, hyperlipidemia, fami ly history, smoking history, drinking history and the incidence of occipital infarction. Finally the risk factors can be determined.Results: 1. General information: From May 2003 to May 2013, 846 patients withmoyamoya disease were treated in neurosurgery department of The 307 th Hospital of Chinese People’s Liberation Army, among which 258 patients suffered form posterior circulation lesion, constituting a portion of 31% of all patients There were 107 moyamoya cases complicated with posterior circulation l esion concomitant with ipsilateral occipital infarction meeting the conditions of enrollment. The probability of occipital infarction was 41.5%. The number of cases in occipital infarction group to that in non-occipital infarction group ratio was 0.71:1. Minimum age in occipital infarction group was 2 years, maximum was 77 years, mean age was 28.66±17.29 years; Minimum age in non-occipital infarction group was 2 years, maximum was 51 years, mean age was 23.16±13.75 years. Male to female ratio in occipital infarction group was 1.14:1; that in non-occipital infarction group was 0.84:1. Diabetes to non-diabetes ratio in occipital infarction group was 0.09:1; that in non-occipital infarction group was 0.06:1. Hypertension to non- hypertension ratio in occipital infarction group was 0.35:1; that in non-occipital infarction group was 0.08:1. Hyperlipidemia to non-hyperlipidemia ratio in occipital infarction group was 0.13:1; that in non-occipital infarction group was 0.09:1. Positive family history to negative family history ratio in occipital infarction group was 0.18:1; that in non-occipital infarction group was 0.16:1; Positive smoking history to negative smoking history ratio in occipital infarction group was 0.18:1; that in non-occipital infarction group was 0.06:1; Positive drinking history to negative drinking history ratio was 0.07:1; that in non-occipital infarction group was 0.02:1. 2. Imaging information: According to the Suzuki’s stage, there were 1 hemisphere in stage I(0.5%), 26 hemispheres in stage II(12.1%), 33 hemispheres in stage III(15.4%), 58 hemispheres in stage IV(27.1%), 75 hemispheres in stage V(35.1%), and 21 hemispheres in stage VI(9.8%) in occipital infarction group. Therewere 15 hemisphere in stage I(5.0%), 53 hemispheres in stage II(17.5%), 65 hemispheres in stage III(21.5%), 64 hemispheres in stage IV(21.2%), 79 hemispheres in stage V(26.2%), and 26 hemispheres in stage VI(8.6%) in non-occipital infarction group. According to the Magikura stage, there were 19 hemisphere in stage 1(8.7%), 77 hemispheres in stage 2(36.1%), 78 hemispheres in stage 3(36.5%), 40 hemispheres in stage 4(18.7%) in occipital infarction group. There were 67 hemisphere in stage 1(22.2%), 148 hemispheres in stage 2(49.0%), 73 hemispheres in stage 3(24.2%), 14 hemispheres in stage 4(4.6%) in non-occipital infarction group. 3. Results of statistical analysis: Univariate analysis was conducted in these 12 factors associated with moyamoya disease complicated with posterior circulation lesion concomitant with ipsilateral occipital infarction. The result showed that statistical differences were found in hypertension, smoking history, age, Suzuki’s stage of left anterior circulation, Suzuki’s stage of left anterior circulation, Magikura stage of left posterior circulation and Magikura stage of right posterior circulation between occipital infarction group and non-occipital infarction group(P<0.05). Multivariate logistic regression analysis was used to these 7 factors so that the risk factors associated with occipital infarction could be determined( OR>1) : hypertension(OR=3.661, 95%CI 1.362-9.836), Magikura stage of left posterior circulation(OR=2.661, 95%CI 1.755-3.886), Magikura stage of right posterior circulation(OR=2.483, 95%CI 1.714-3.597), age(OR=1.029, 95%CI 1.007-1.053)Conclusion: 1. Significant association was found between moyamoya disease complicated with posterior circulation lesion concomitant with ipsilateral occipital infarction and age, Magikura stage of posterior circulation and hyperte nsion. The standardregression coefficient and OR value revealed that hypertension constituted a larger portion of risk than the Magikura stage of posterior circulation and age. The Magikura stage of posterior circulation came in the second place and age stayed at last. 2. No statistical differences of sexes, diabetes, hyper lipids, family history and drinking history were found between occipital infarction group and non-occipital infarction group. Statistical differences of Smoking history and Suzuki’s stage of anterior circulation were found between two groups, but none of these differences showed influence on the statistical outcome of occurrence of occipital infarction. 3. For the patients who have moyamoya disease complicated with posterior circulation lesion, especially for the patients who are aged and suffer from higher level of Magikura stage of posterior circulation and hypertension, even though ther e is no obvious symptom, surgical treatment is highly recommended. |
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