Comparative Analysis Of Ischemic And Hemorrhagic Moyamoya Disease In Adults

Objective:Comparative analysis of cerebral infarction and cerebral hemorrhage in Moyamoya disease(MMD)from two aspects of general data and imaging manifestations,and to explore the risk factors of ischemic and hemorrhagic phenotypes of Moyamoya disease.Methods:A total of 105 patients with Moyamoya disease from January 2019 to December2021 were retrospectively recruited in the First Affiliated Hospital of Nanchang University.All patients had completed Digital subtraction angiography(DSA)and had acute hemorrhages or infarctions shown by head Computed tomography(CT)or Magnetic resonance imaging(MRI).The subjects were divided into two groups,56 cases of cerebral infarction group and 49 cases of cerebral hemorrhage group.The general information and imaging findings(including CT、MRI and DSA)of the subjects were collected.The data of the two groups of patients were compared and analyzed.Results:1、 General information :There were 36 female patients and 69 male patients in this study,with more males than females,but the difference was not statistically significant(P = 0.621).Age of onset in cerebral infarction group was 53.46 ± 9.531 years old,and the cerebral hemorrhage group was 49.86 ± 7.533 years old,with a significant age difference between the two groups(P = 0.036).The incidence of hypertension in the cerebral infarction group was significantly higher than the cerebral hemorrhage group(P = 0.01).Dyslipidemia in the cerebral infarction group was significantly higher than the cerebral hemorrhage group(P = 0.016).Analysis of laboratory data showed that Creatine kinase(CK)and D-dimer in cerebral hemorrhage group were significantly higher than those in cerebral infarction group(P = 0.04;P < 0.01).2、 Imaging manifestations :CT and MRI : A total of 105 patients were recruited,and acute stroke occurred in 128 cerebral hemispheres,including 67 cerebral hemisphere infarctions(11bilateral)and 61 cerebral hemisphere hemorrhages(12 bilateral).According to the distribution of arterial blood supply,cerebral infarctions was divided into Anterior cerebral artery(ACA)infarctions,Middle cerebral artery(MCA)infarctions,Posterior cerebral artery(PCA)infarctions,perforator infarctions and watershed infarctions(including anterior and posterior).Cortical lesions were more than deep lesions.Cerebral hemorrhages can be divided into basal ganglia hemorrhages,thalamic hemorrhages,paraventricular hemorrhages,intraventricular hemorrhages,subarachnoid hemorrhages and lobar hemorrhages according to the structure of the cerebral hemisphere.The deep part of the brain was composed of the basal ganglia,thalamus and paraventricular,and intraventricular hemorrhages accounted for a higher proportion.DSA : Most of the patients in the two groups were in Suzuki stage Ⅲ and Ⅳ,the number of Suzuki stage Ⅲ in the cerebral infarction group was higher than that in the cerebral hemorrhage group(P = 0.08),and the Ⅳ stage was significantly increased in the cerebral hemorrhage group(P = 0.01).Leptomeningeal collateral branches in the cerebral infarction group were significantly more than those in the cerebral hemorrhage group(P = 0.013),and lateral cervical branches,posterior circulation compensatory vessels and deep penetrating branches in the cerebral hemorrhage group were significantly higher than the cerebral infarction group(P =0.03;P = 0.045;P = 0.024).There was no aneurysm formation in the cerebral infarction group,and aneurysms were found in 8 hemispheres in the cerebral hemorrhage group,and the difference was significant between the two groups(P =0.02).In the cerebral infarction group,MCA and PCA were more involved than in the cerebral hemorrhage group,and the difference was not statistically significant between the two groups(P=0.531;P=0.255);ACA lesions in the cerebral hemorrhage group was significantly higher than that in the cerebral infarction group(P = 0.025).3、 Multivariate regression analysis :Cerebral infarction : Age,hypertension,dyslipidemia,and leptomeningeal collaterals were associated with cerebral infarction.By multivariate analysis,dyslipidemia and hypertension were independent risk factors for cerebral infarction(dyslipidemia : OR = 2.921,P = 0.028,95%CI(1.124-7.589);hypertension : OR= 3.344,P = 0.006,95%CI(1.421-7.868)).Cerebral hemorrhage : CK,D-dimer,Suzuki stage Ⅳ,the posterior circulation compensation,the deep perforating branch,the lateral cervical branch,aneurysm,ACA lesions were associated with cerebral hemorrhage.The deep penetrating branch was an independent risk factor for cerebral hemorrhage(OR = 15.338,P = 0.003,95%CI(2.555-92.058)),D-dimer and CK were independent risk factors for cerebral hemorrhage(D-dimer : OR = 9.955,P = 0.001,95%CI(2.459-40.308);CK : OR = 1.012,P = 0.032,95%CI(1.001-1.023)).Conclusions :Through the detailed univariate and multivariate analysis of the general data and imaging manifestations of cerebral infarction and cerebral hemorrhage in Moyamoya disease,results show that: dyslipidemia and hypertension were independent risk factors of ischemic Moyamoya disease;the deep penetrating branch was an independent risk factor of cerebral hemorrhage in Moyamoya disease,we can think that the richer the deep perforating branch,that is,the more abnormal expansion of blood vessels such as the choroidal artery,lenticulostriate artery,and thalamic perforating artery in the deep brain,the greater the possibility of cerebral hemorrhage;CK and D-dimer were independent risk factors for hemorrhagic Moyamoya disease.