Original Paper
Failure of Primary Percutaneous Angioplasty and Stenting in the Prevention of Ischemia in Moyamoya AngiopathyKhan N.a · Dodd R.a, b · Marks M.P.a, b · Bell-Stephens T.a · Vavao J.a · Steinberg G.K.aDepartments of aNeurosurgery and bRadiology, Stanford Stroke Center, and Stanford Institute for Neuro-Innovation and Translational Neurosciences, Stanford University School of Medicine, Stanford, Calif., USA
Keywords: AngioplastyMoyamoyaWingspan stent |
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Article / Publication Details
Received: June 18, 2010
Accepted: August 02, 2010
Published online: December 04, 2010
Issue release date: January 2011
Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 1
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: https://www.karger.com/CED
Abstract
Background: Moyamoya disease (MMD) is an idiopathic progressive arteriopathy affecting the proximal intracranial vasculature. To date only 4 case reports on intracranial angioplasty or stenting as treatment of this disease exist. We present 5 adult patients with MMD who failed angioplasty and/or stenting who remained symptomatic despite endovascular treatment or presented with recurrent symptoms and recurrence of stenosis/occlusion on angiography requiring subsequent extracranial-intracranial revascularization. Methods: Five adult MMD patients who underwent endovascular treatment with angioplasty or stenting were referred for further evaluation and treatment from outside hospitals. Data were collected from clinical referral notes and angiograms or reports. All patients underwent repeat 6-vessel cerebral angiography to assess the extent of disease and results of prior endovascular treatment. Results: Six endovascular procedures were performed in all 5 patients. Internal carotid artery (ICA) balloon angioplasty and Wingspan stenting was performed in 2 patients (3 arteries). One patient had ICA-M1 angioplasty without stenting. Two patients had M1 angioplasty and Wingspan stenting. All patients developed repeat transient ischemic attacks following treatment attributable to the vascular territories of endovascular treatment. Repeat endovascular treatment was performed in 3 patients at a mean of 4 months (range = 2–6). Two went on to a third endovascular treatment due to progression of disease in the angioplastied/stented vessel. The average time of symptom recurrence after initial endovascular therapy was 1.8 months (0–4 months). Follow-up angiography when referred to our institution demonstrated 70–90% instent restenosis of the stented vessel in 3 and occlusion in 1 patient. Due to persistence of symptoms cerebral revascularization was performed in all patients. Conclusion: MMD is a progressive angiopathy. Angioplasty and stenting may temporarily improve the cerebral blood flow and decrease cerebral ischemic events but do not appear to be durable nor provide long-term prevention against future ischemic events.
© 2010 S. Karger AG, Basel
References
- Fukui M, research committee on spontaneous occlusion of the circle of Willis (moyamoya disease) of the Ministry of Health and Welfare, Japan: Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis (‘moyamoya’ disease). Clin Neurol Neurosurg 1997;99(suppl 2):S238–S240.
- Golby AJ, Marks MP, Thompson RC, Steinberg GK: Direct and combined revascularization in pediatric moyamoya disease. Neurosurgery 1999;45:50–58; discussion 58–60.
- Suzuki J, Takaku A: Cerebrovascular ‘moyamoya’ disease: disease showing abnormal net-like vessels in base of brain. Arch Neurol 1969;20:288–299.
- Yonekawa Y, Kahn N: Moyamoya disease. Adv Neurol 2003;92:113–118.
- Drazin D, Calayag M, Gifford E, Dalfino J, Yamamoto J, Boulos AS: Endovascular treatment for moyamoya disease in a Caucasian twin with angioplasty and wingspan stent. Clin Neurol Neurosurg 2009;111:913–917.
-
El-Hakam LM, Volpi J, Mawad M, Clark G: Angioplasty for acute stroke with pediatric moyamoya syndrome. J Child Neurol 2010, Epub ahead of print
- Kornblihtt LI, Cocorullo S, Miranda C, Lylyk P, Heller PG, Molinas FC: Moyamoya syndrome in an adolescent with essential thrombocythemia: successful intracranial carotid stent placement. Stroke 2005;36:E71–E73.
- Rodriguez GJ, Kirmani JF, Ezzeddine MA, Qureshi AI: Primary percutaneous transluminal angioplasty for early moyamoya disease. J Neuroimaging 2007;17:48–53.
- Kelly ME, Bell-Stephens TE, Marks MP, Do HM, Steinberg GK: Progression of unilateral moyamoya disease: a clinical series. Cerebrovasc Dis 2006;22:109–115.
- Kuroda S, Ishikawa T, Houkin K, Nanba R, Hokari M, Iwasaki Y: Incidence and clinical features of disease progression in adult moyamoya disease. Stroke 2005;36:2148–2153.
-
Takahashi A, Fujiwara S, Suzuki J: Long-term follow-up angiography of moyamoya disease – cases followed from childhood to adolescence. No Shinkei Geka 1986;14:23–29.
- Marks MP, Wojak JC, Al-Ali F, Jayaraman M, Marcellus ML, Connors JJ, Do HM: Angioplasty for symptomatic intracranial stenosis: clinical outcome. Stroke 2006;37:1016–1020.
- Wojak JC, Dunlap DC, Hargrave KR, DeAlvare LA, Culbertson HS, Connors JJ 3rd: Intracranial angioplasty and stenting: long-term results from a single center. AJNR Am J Neuroradiol 2006;27:1882–1892.
- Albuquerque FC, Levy EI, Turk AS, Niemann DB, Aagaard-Kienitz B, Pride GL Jr, Purdy PD, Welch BG, Woo HH, Rasmussen PA, Hopkins LN, Masaryk TJ, McDougall CG, Fiorella DJ: Angiographic patterns of wingspan in-stent restenosis. Neurosurgery 2008;63:23–27; discussion 27–28.
- Levy EI, Turk AS, Albuquerque FC, Niemann DB, Aagaard-Kienitz B, Pride L, Purdy P, Welch B, Woo H, Rasmussen PA, Hopkins LN, Masaryk TJ, McDougall CG, Fiorella DJ: Wingspan in-stent restenosis and thrombosis: incidence, clinical presentation, and management. Neurosurgery 2007;61:644–650; discussion 650–651.
- Turk AS, Levy EI, Albuquerque FC, Pride GL Jr, Woo H, Welch BG, Niemann DB, Purdy PD, Aagaard-Kienitz B, Rasmussen PA, Hopkins LN, Masaryk TJ, McDougall CG, Fiorella D: Influence of patient age and stenosis location on wingspan in-stent restenosis. AJNR Am J Neuroradiol 2008;29:23–27.
- Guzman R, Lee M, Achrol A, Bell-Stephens T, Kelly M, Do HM, Marks MP, Steinberg GK: Clinical outcome after 450 revascularization procedures for moyamoya disease: clinical article. J Neurosurg 2009;111:927–935.
- Houkin K, Kuroda S, Nakayama N: Cerebral revascularization for moyamoya disease in children. Neurosurg Clin N Am 2001;12:575–584, ix.
- Ikezaki K: Rational approach to treatment of moyamoya disease in childhood. J Child Neurol 2000;15:350–356.
- Khan N, Schuknecht B, Boltshauser E, Capone A, Buck A, Imhof HG, Yonekawa Y: Moyamoya disease and moyamoya syndrome: experience in Europe; choice of revascularisation procedures. Acta Neurochir (Wien) 2003;145:1061–1071; discussion 1071.
- Scott RM: Moyamoya syndrome: a surgically treatable cause of stroke in the pediatric patient. Clin Neurosurg 2000;47:378–384.
- Scott RM, Smith JL, Robertson RL, Madsen JR, Soriano SG, Rockoff MA: Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis. J Neurosurg 2004;100:142–149.
Article / Publication Details
Received: June 18, 2010
Accepted: August 02, 2010
Published online: December 04, 2010
Issue release date: January 2011
Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 1
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: https://www.karger.com/CED
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