Study On The Differences Of Collateral Vessel Compensation In Moyamoya Syndrome Based On Different Hemorrhagic Types

Objective:To explore the difference of important collateral circulation in different type of hemorrhagic moyamoya syndrome(MMS).Methods:45 hemorrhagic MMS patients that admitted to our hospital between July 2013 and March 2019 were retrospectively analysed.Patients were assigned to four types according to the hemorrhagic site:Thalamic hemorrhage?Striatum hemorrhage?Cerebral lobe hemorrhage and Intraventricular hemorrhage.All patients had undertook cranial DSA examination.Separately evaluating and grading the degree of expansion of the five importment collateral vessels of lenticulostriate artery(LSA)?anterior choroidal artery(AChA)?posterior choroidal artery(PChA)?posterior communicating artery(PComA)?thalamic perforating artery(TPA),calculating the dilatation rate of each collateral vessel in different hemorrhagic type,one-way analysis of variance was used to compare the age of different types,and?~2test of paired sample comparison was used to compare the clinical characteristics of collateral vessel dilatation rate,gender,and clinical features among different hemorrhagic types.Results:Among the 45 MMS patients,thalamic hemorrhage were 12cases,striatum hemorrhage were 13 cases,cerebral lobe hemorrhage were 13cases and Intraventricular hemorrhage were 7 cases.LSA?AChA?PComA showed pronounced dilation in all four hemorrhagic types,LSA had the highest expansion rate in thalamic hemorrhage,striatum hemorrhage,and cerebral lobe hemorrhage,expansion rates respectively were 66.7%?77.0%?77.0%;AChA has the highest expansion rate in the ventricular hemorrhage group,with an expansion rate of 69.2%.However,expansion rate comparisons between groups show there was no significant differences in different hemorrhagic types.PChA had different expansion rates in the four types,with the highest expansion rate in the thalamic hemorrhage type(58.3%),the difference was statistically significant(?~2=9.674,P<0.05).TPA only dilated in thalamic hemorrhage type with the expansion rate of 25%,the difference was statistically significant(?~2=9.347,P<0.05).Conclusions:The collateral vessels of MMS patients showed different degrees of compensatory expansion under different bleeding patterns,and LSA showed a higher expansion rate in each subgroup of MMS bleeding,AChA and PComA have the highest dilation rate in the subgroup of MMS ventricular hemorrhage,PChA and TPA had the highest expansion rate in the MMS thalamic hemorrhage group,inferring that TPA and PChA may be independent risk factors for thalamic hemorrhage.