Persistent Periventricular Anastomosis Associated With Rebleeding After Bypass Surgery for Hemorrhagic Moyamoya Disease
Background Although bypass surgery can reduce rebleeding risk in hemorrhagic moyamoya disease, the risk remaining after surgery is not negligible. We hypothesized that the postoperative persistence of periventricular anastomosis (PA), a fragile periventricular collateral manifestation, is associated...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-03-01
|
| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.124.001653 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849726872640815104 |
|---|---|
| author | Eika Hamano Takeshi Funaki Hiroharu Kataoka Yu Hidaka Takayuki Kikuchi Yohei Mineharu Hideo Chihara Kazumichi Yoshida Yasushi Takagi Jun C. Takahashi Koji Iihara Susumu Miyamoto Yoshiki Arakawa |
| author_facet | Eika Hamano Takeshi Funaki Hiroharu Kataoka Yu Hidaka Takayuki Kikuchi Yohei Mineharu Hideo Chihara Kazumichi Yoshida Yasushi Takagi Jun C. Takahashi Koji Iihara Susumu Miyamoto Yoshiki Arakawa |
| author_sort | Eika Hamano |
| collection | DOAJ |
| description | Background Although bypass surgery can reduce rebleeding risk in hemorrhagic moyamoya disease, the risk remaining after surgery is not negligible. We hypothesized that the postoperative persistence of periventricular anastomosis (PA), a fragile periventricular collateral manifestation, is associated with rebleeding. Methods This retrospective cohort study included patients with moyamoya disease who underwent direct bypass at 2 institutions after hemorrhagic presentation. Either presence or absence of PA after surgery was radiologically determined by grading of each subtype, lenticulostriate, thalamic, or choroidal anastomosis, 3–6 months after surgery. The time interval between the surgery and the rebleeding event or last visit was calculated. Results Of 116 eligible patients comprising 232 hemispheres, 172 hemispheres underwent surgery. Rebleeding occurred in 16 hemispheres of 15 patients (2.0% per person‐year) during the median follow‐up period of 6.3 years. The hemisphere‐based annual rebleeding rate was 2.0% in the PA‐positive hemispheres as compared with 0.46% in the PA‐negative hemispheres. The adjusted hazard ratio of rebleeding for positive PA relative to negative PA was 4.11 (95% CI, 1.07–15.82). Among subtypes of PA, lenticulostriate anastomosis was the most likely to persist after surgery (34 of 62 anastomoses) and to cause rebleeding (8 of 16 hemispheres). Conclusion The persistence of PA, especially that of lenticulostriate anastomosis, might be associated with rebleeding after surgery. This suggests the importance of assessing and optimally managing PA for improving long‐term outcomes. |
| format | Article |
| id | doaj-art-073f87a12de9405c9442de9876f3003f |
| institution | DOAJ |
| issn | 2694-5746 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj-art-073f87a12de9405c9442de9876f3003f2025-08-20T03:10:03ZengWileyStroke: Vascular and Interventional Neurology2694-57462025-03-015210.1161/SVIN.124.001653Persistent Periventricular Anastomosis Associated With Rebleeding After Bypass Surgery for Hemorrhagic Moyamoya DiseaseEika Hamano0Takeshi Funaki1Hiroharu Kataoka2Yu Hidaka3Takayuki Kikuchi4Yohei Mineharu5Hideo Chihara6Kazumichi Yoshida7Yasushi Takagi8Jun C. Takahashi9Koji Iihara10Susumu Miyamoto11Yoshiki Arakawa12Department of Neurosurgery National Cerebral and Cardiovascular Center Osaka JapanDepartment of Neurosurgery Kyoto University Graduate School of Medicine Kyoto JapanDepartment of Neurosurgery National Cerebral and Cardiovascular Center Osaka JapanDepartment of Biomedical Statistics and Bioinformatics Kyoto University Graduate School of Medicine Kyoto JapanDepartment of Neurosurgery Kyoto University Graduate School of Medicine Kyoto JapanDepartment of Neurosurgery Kyoto University Graduate School of Medicine Kyoto JapanDepartment of Neurosurgery Kyoto University Graduate School of Medicine Kyoto JapanDepartment of Neurosurgery Shiga University of Medical Science Shiga JapanDepartment of Neurosurgery Tokushima University Graduate School of Biomedical Sciences Tokushima JapanDepartment of Neurosurgery Kindai University Faculty of Medicine Osaka JapanDepartment of Neurosurgery National Cerebral and Cardiovascular Center Osaka JapanMoyamoya Disease Support Center Kyoto University Hospital Kyoto JapanDepartment of Neurosurgery Kyoto University Graduate School of Medicine Kyoto JapanBackground Although bypass surgery can reduce rebleeding risk in hemorrhagic moyamoya disease, the risk remaining after surgery is not negligible. We hypothesized that the postoperative persistence of periventricular anastomosis (PA), a fragile periventricular collateral manifestation, is associated with rebleeding. Methods This retrospective cohort study included patients with moyamoya disease who underwent direct bypass at 2 institutions after hemorrhagic presentation. Either presence or absence of PA after surgery was radiologically determined by grading of each subtype, lenticulostriate, thalamic, or choroidal anastomosis, 3–6 months after surgery. The time interval between the surgery and the rebleeding event or last visit was calculated. Results Of 116 eligible patients comprising 232 hemispheres, 172 hemispheres underwent surgery. Rebleeding occurred in 16 hemispheres of 15 patients (2.0% per person‐year) during the median follow‐up period of 6.3 years. The hemisphere‐based annual rebleeding rate was 2.0% in the PA‐positive hemispheres as compared with 0.46% in the PA‐negative hemispheres. The adjusted hazard ratio of rebleeding for positive PA relative to negative PA was 4.11 (95% CI, 1.07–15.82). Among subtypes of PA, lenticulostriate anastomosis was the most likely to persist after surgery (34 of 62 anastomoses) and to cause rebleeding (8 of 16 hemispheres). Conclusion The persistence of PA, especially that of lenticulostriate anastomosis, might be associated with rebleeding after surgery. This suggests the importance of assessing and optimally managing PA for improving long‐term outcomes.https://www.ahajournals.org/doi/10.1161/SVIN.124.001653cerebral revascularizationcohort studymoyamoya diseaseperiventricular anastomosis |
| spellingShingle | Eika Hamano Takeshi Funaki Hiroharu Kataoka Yu Hidaka Takayuki Kikuchi Yohei Mineharu Hideo Chihara Kazumichi Yoshida Yasushi Takagi Jun C. Takahashi Koji Iihara Susumu Miyamoto Yoshiki Arakawa Persistent Periventricular Anastomosis Associated With Rebleeding After Bypass Surgery for Hemorrhagic Moyamoya Disease Stroke: Vascular and Interventional Neurology cerebral revascularization cohort study moyamoya disease periventricular anastomosis |
| title | Persistent Periventricular Anastomosis Associated With Rebleeding After Bypass Surgery for Hemorrhagic Moyamoya Disease |
| title_full | Persistent Periventricular Anastomosis Associated With Rebleeding After Bypass Surgery for Hemorrhagic Moyamoya Disease |
| title_fullStr | Persistent Periventricular Anastomosis Associated With Rebleeding After Bypass Surgery for Hemorrhagic Moyamoya Disease |
| title_full_unstemmed | Persistent Periventricular Anastomosis Associated With Rebleeding After Bypass Surgery for Hemorrhagic Moyamoya Disease |
| title_short | Persistent Periventricular Anastomosis Associated With Rebleeding After Bypass Surgery for Hemorrhagic Moyamoya Disease |
| title_sort | persistent periventricular anastomosis associated with rebleeding after bypass surgery for hemorrhagic moyamoya disease |
| topic | cerebral revascularization cohort study moyamoya disease periventricular anastomosis |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.124.001653 |
| work_keys_str_mv | AT eikahamano persistentperiventricularanastomosisassociatedwithrebleedingafterbypasssurgeryforhemorrhagicmoyamoyadisease AT takeshifunaki persistentperiventricularanastomosisassociatedwithrebleedingafterbypasssurgeryforhemorrhagicmoyamoyadisease AT hiroharukataoka persistentperiventricularanastomosisassociatedwithrebleedingafterbypasssurgeryforhemorrhagicmoyamoyadisease AT yuhidaka persistentperiventricularanastomosisassociatedwithrebleedingafterbypasssurgeryforhemorrhagicmoyamoyadisease AT takayukikikuchi persistentperiventricularanastomosisassociatedwithrebleedingafterbypasssurgeryforhemorrhagicmoyamoyadisease AT yoheimineharu persistentperiventricularanastomosisassociatedwithrebleedingafterbypasssurgeryforhemorrhagicmoyamoyadisease AT hideochihara persistentperiventricularanastomosisassociatedwithrebleedingafterbypasssurgeryforhemorrhagicmoyamoyadisease AT kazumichiyoshida persistentperiventricularanastomosisassociatedwithrebleedingafterbypasssurgeryforhemorrhagicmoyamoyadisease AT yasushitakagi persistentperiventricularanastomosisassociatedwithrebleedingafterbypasssurgeryforhemorrhagicmoyamoyadisease AT junctakahashi persistentperiventricularanastomosisassociatedwithrebleedingafterbypasssurgeryforhemorrhagicmoyamoyadisease AT kojiiihara persistentperiventricularanastomosisassociatedwithrebleedingafterbypasssurgeryforhemorrhagicmoyamoyadisease AT susumumiyamoto persistentperiventricularanastomosisassociatedwithrebleedingafterbypasssurgeryforhemorrhagicmoyamoyadisease AT yoshikiarakawa persistentperiventricularanastomosisassociatedwithrebleedingafterbypasssurgeryforhemorrhagicmoyamoyadisease |