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Characteristics of cerebral ischemic stroke based on moyamoya disease and atherosclerosis-associated intracranial arterial stenosis

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Abstract

Purpose

To analyze the characteristics of acute ischemic stroke (AIS) resulting from moyamoya disease (MMD) and intracranial large artery atherosclerotic stenosis (LAS).

Method

This real-world case control study enrolled imaging-confirmed AIS patients owing to MMD or LAS hospitalized from January 2015 through September 2020 consecutively. The features of risk factors, peripheral blood, and imaging presentations were compared between the two cohorts.

Results

A total of 191 eligible patients entered into final analysis, including 70 cases with MMD stroke and 121 with LAS stroke. LAS stroke vs. MMD stroke, the ratios of hyperlipidemia, hypertension, diabetes, and hyperhomocysteinemia were higher in the former (65.3 vs.12.9%, 65.3% vs. 4.3%, 39.7% vs. 2.9%, and 43.8% vs.12.9%; all p < 0.01) as well as baseline plasma arachidonic acid (AA) and adenosine diphosphate (ADP)-stimulated maximum platelet aggregation rates (75.3% vs. 60.8% and 73.1% vs.64.9%, respectively, all p < 0.01), which were positively correlated with triglycerides and cholesterol levels, blood glucose, age, and platelet counts (all p < 0.01). Classical watershed infarction (WSI) accounted for 87.14% in MMD stroke and 40.49% in LAS stroke, respectively (p < 0.01). Almost all of the patients with LAS showed plaques in arterial walls on CTA maps and non-homogeneous thickening with irregular luminal narrowing on HRMRI, while plaques were seldom found in MMD besides homogeneous thickening with regular luminal narrowing.

Conclusions

Differing from LAS stroke, MMD stroke mainly presents with WSI and does not feature with platelet hyper-aggregation and fragmentation of ulcer plaque. Whereby, focusing on perfusion improvement rather than antiplatelets and statins may be the predominant step in MMD-stroke correction.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AA%:

Arachidonic acid–induced platelet maximum aggregation rate

ADP%:

Adenosine diphosphate–induced platelet maximum aggregation rate

MMD:

Moyamoya disease

RIC:

Remote ischemic conditioning

WSI:

Watershed infarction

TOAST:

Trial of org in acute stroke treatment

DWI:

Diffusion-weighted imaging

LAS:

Large artery atherosclerotic stenosis

MRI:

Magnetic resonance imaging

ICA:

Internal carotid artery

MCA:

Middle cerebral artery

ACA:

Anterior cerebral artery

CTA:

Computed tomography angiography

DSA:

Digital subtraction angiography

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Acknowledgements

We would like to thank all patients and doctors who participated in this study for their cooperation.

Funding

This study was sponsored by the National Key R&D Program (2017YFC1308401), the National Natural Science Foundation (81660209, 81801143), and the Beijing Natural Science Foundation (7212047).

Author information

Authors and Affiliations

  1. Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China

    Zhiying Chen, Xiaoqin Wu, Da Zhou, Shuling Shang & Ran Meng

  2. Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China

    Zhiying Chen, Xiaoqin Wu, Da Zhou, Xunming Ji & Ran Meng

  3. Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China

    Zhiying Chen, Xiaoqin Wu, Da Zhou, Yuchuan Ding, Xunming Ji & Ran Meng

  4. Department of Neurology, Xiehe Hospital, Tangshan, Hebei, 063000, China

    Shuling Shang

  5. Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, 48201, USA

    Yuchuan Ding

Authors
  1. Zhiying Chen
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Contributions

(I) Conception and design: Zhiying Chen, Ran Meng. (II) Administrative support: Zhiying Chen, Da Zhou. (III) Provision of study materials: Zhiying Chen, Xiaoqin Wu. (IV) Collection and assembly of data. Zhiying Chen, Xiaoqin Wu, Shuling Shang. (V) Data analysis and interpretation: Zhiying Chen, Xiaoqin Wu. (VI) Manuscript writing: all authors.

(VII) Final approval of manuscript: all authors.

(VIII) The final version has been revised by Ran Meng, Yuchuan Ding, and Xunming Ji.

Corresponding author

Correspondence to Ran Meng.

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Ethics approval

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was approved by the Ethics Committee of Xuanwu Hospital, Capital Medical University, and all participants signed the consent forms before enrolment.

Consent for publication

Written informed consent was obtained from the patients’ parents and participants for publication of this case report and any accompanying images.

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The authors declare that they have no conflict of interest.

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All subjects participating in the image acquisition signed the informed consent form.

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Chen, Z., Wu, X., Zhou, D. et al. Characteristics of cerebral ischemic stroke based on moyamoya disease and atherosclerosis-associated intracranial arterial stenosis. Neurol Sci 43, 1087–1096 (2022). https://doi.org/10.1007/s10072-021-05359-z

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  • DOI: https://doi.org/10.1007/s10072-021-05359-z

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