The Correlations Between The Lesion Degree And Initial Hemorrhagic Events In Adult Patients With Moyamoya Disease Based On Mugikura Stages

Objective The purpose of this study was to explore the influence of the severity of moyamoya disease on the internal carotid artery and its branches,and the moyamoya vessels,and explore the factors affecting the incidence of intracerebral hemorrhage in adult patients.Methods A total of 98 patients(40 patients with hemorrhagic)who were diagnosed with Moyamoya disease at the Zhujiang Hospital of Southern Medical University(Guangzhou,China)from September 2011 to March 2019 were recruited.The right and left hemispheres were individually classified as the hemorrhagic group and non-hemorrhagic group according to the cranial computed(CT)tomography.The radiological data and clinical data of each hemispheres were carefully reviewed by neurosurgeons separately.The stage of the moyamoya disease was assessed according to the criteria that approved by Mugikura.The AChA and PComA and ophthalmic artery(OA)and moyamoya vessel and the collateral circulation were graded according to it's morphological characteristics in the images of angiograpgy.We measured the vessels diameter of AChA and PComA and OA and internal carotid artery(ICA).The SPSS 22.0 software(IBM,Armonk,NY,USA)was used to analyze the data.P<0.05 was considered statistically significant.Statistical analysis was performed to determine whether the changes in the parameters of these vessels were related to the degree of lesion in patients.The effects of the above factors on intracerebral hemorrhage were also calculated.Result As the univariate analysis showed,the stage of AChA(Z=-4.016,P<0.001),the internal diameter of AChA(t=-3.479,P=0.001),the ratio of internal diameter of AChA to ICA(t=-4.3 65,P=<0.001),the stage of PComA(Z=-3.201,P=0.001),the internal diameter of PComA(t=-3.140,P=0.003),the ratio of internal diameter of PComA to ICA(t=-3.310,P=0.002),the stage of OA(Z=-2.789,P=0.005),the internal diameter of OA(t=-2.166,P=0.032),the stage of collateral circulation(Z=-2.267,P=0.023),the stage of moyamoya vessel(Z=-3.334,P=0.001)exist statistically differences between hemorrhagic and non-hemorrhagic groups.With the Mugikural stage ascended from 1 to 3,the intracerebral hemorrhage rate increased as well.The positive linear correlation between them was statistically significant(R=0.287,P<0.001).With the Mugikural stage descended from 3 to 4,the intracerebral hemorrhage rate decreased as well.The negative linear correlation between them was statistically significant(R=-0.227,P=0.014).The AChA and PComA and OA and moyamoya vessel have a similar correlation with the Mugikural stage.The results of regression analysis under different parameters showed that the inner diameter of the anterior choroidal artery and posterior communicating artery,as well as the imaging stage,and the ratio of the inner diameter of the above vessels to the internal carotid artery were all statistically correlated with the intracerebral hemorrhage events of the patients.The sensitivity and specificity of cerebral hemorrhage risk prediction were 30.0%and 97.4%,respectively,when the ratio of PComA to ICA and the ratio of AChA to ICA were incldded.Result The AChA and PComA dilated and supplied to other regions as collateral branches are risk factors of intracerebral hemorrhage.The internal diameters of these vessels or their ratio to internal carotid arteries can be used as predictors of the risk of intracerebral hemorrhage in patients with moyamoya disease.And their ratio to internal carotid arteries is the best predictor.The anterior cerebral circulation will affect the dilation and atrophy degree of the AChA and PComA,and ultimately affects the patient's risk of cerebral hemorrhage.