Impact of Endothelial Shear Stress on the Bilateral Progression of Unilateral Moyamoya Disease
Impact of Endothelial Shear Stress on the Bilateral Progression of Unilateral Moyamoya Disease
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DOI：
10.1161/strokeaha.119.028117
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发表时间：
2020-03-01
期刊：
影响因子：
8.3
通讯作者：
Jung, Keun-Hwa
中科院分区：
文献类型：
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作者：
Lee, Woo-Jin;Jeong, Seul-Ki;Jung, Keun-Hwa
背景和目的：在单侧烟雾病中，完整侧终末颈内动脉内皮切应力的改变可能触发双侧烟雾病的进展。我们分析了内皮剪切应力参数的正常出现终端颈内动脉在单侧烟雾病及其与双边diseases.Methods的进展，这一回顾性队列研究包括患者诊断为单侧烟雾病的脑血管造影和随访定期磁共振成像/磁共振血管造影评价>1年。在初始脑磁共振成像/磁共振血管造影的飞行时间序列中，获得的内皮剪切应力参数为血管边界处的平均和最大信号强度梯度（SIG）和SIG SD。侧侧疾病进展定义为在随访磁共振成像/磁共振血管造影评估中，在先前完整的脑侧检测到新发展的血管狭窄闭塞，磁共振血管造影狭窄闭塞阶段>= 2。（66例男性[45.2%]和80例女性[54.8%]; 76例儿童[52.1%]），平均随访4.3 ± 2.4年后，43例患者（29.5%）检测到对侧疾病进展。多变量分析显示，SIG SD与该进展显著相关（比值比，13.001 [95%CI，1.764-95.794]，P=0.012）。在受试者工作特征曲线分析中，SIG SD预测对侧进展的曲线下面积为0.803（95%CI，0.726-0.880，P
Background and Purpose- In unilateral moyamoya disease, altered endothelial shear stress on the intact-side terminal internal carotid artery might trigger the progression to bilateral disease. We analyzed the endothelial shear stress parameters of the normally appearing terminal internal carotid artery in unilateral moyamoya disease and its association with the progression to bilateral disease.Methods- This retrospective cohort study included patients diagnosed with unilateral moyamoya disease by cerebral angiography and followed-up with regular magnetic resonance imaging/magnetic resonance angiography evaluations for >1 year. Endothelial shear stress parameters acquired were mean and maximum signal intensity gradients (SIG) and SIG SD at the vessel boundary in time-of-flight sequences in initial brain magnetic resonance imaging/magnetic resonance angiography. Contralateral disease progression defined as the detection of newly developed vessel steno-occlusion with an magnetic resonance angiography steno-occlusive stage of >= 2, in the previously intact side of the brain on follow-up magnetic resonance imaging/magnetic resonance angiography evaluation.Results- Among 146 patients (66 males [45.2%] and 80 females [54.8%]; 76 pediatric [52.1%]), contralateral disease progression was detected in 43 patients (29.5%) after a mean follow-up of 4.3 +/- 2.4 years. Multivariate analysis showed that SIG SD was significantly associated with this progression (odds ratio, 13.001 [95% CI, 1.764-95.794], P=0.012). In receiver operating characteristic curve analysis, SIG SD predicted the contralateral progression with area under the curve values of 0.803 (95% CI, 0.726-0.880, P