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MRA head showing a right intracranial internal carotid artery stenosis, with marked focal stenosis along the proximal supraclinoid segment, moderate stenosis along its distal supraclinoid segment with marked stenosis along the origin of the right A1 segment.
Source publication
Moyamoya disease (MMD) primarily causes constriction of internal carotid artery, but it is known to extend to the middle and anterior cerebral arteries. Some of the symptoms caused by MMD include transient ischemic attack (TIA) and seizures. The etiology of MMD from Graves' disease (GD) is mostly caused by thyrotoxicosis, but our finding of leukocy...
Context in source publication
Context 1
... in- tercranial hemorrhage and stat EKG showed a sinus rhythm. MRA of head showed a right intracranial internal carotid artery stenosis, with marked focal stenosis along the proximal supra- Res. 2015;7(8):643-645 clinoid segment, moderate stenosis along its distal supraclinoid segment with marked stenosis along the origin of the right A1 segment (Fig. 1). Furthermore, there was a marked stenosis of the left intracranial internal carotid artery along its petrous, cav- ernous and proximal supraclinoid segments. Multiple stenoses along segments of both posterior cerebral arteries, both superior cerebellar arteries, both anterior inferior cerebral arteries, and the left posterior interior ...
Citations
... Three cases reported a general symptomatic improvement after IVT and/or ET. Jehangir et al. reported a 26 year old female patient with background HTN and Graves' disease who was hospitalised for cough, shortness of breath and haemoptysis [8]. During admission, she developed R arm paraesthesia and weakness, R facial droop and slurred speech. ...
... Previous research has noted a higher overall prevalence of MMD in patients with autoimmune conditions [29], which was seen in the patients reported by Jehangir et al. and Ahmad et al. [8,15]. While results were unreported for the case reported by Ahmad et al., Jehangir et al. reported general symptomatic improvement after IVT use in an MMD-associated AIS patient with background Graves' disease, suggesting a thrombotic cause of ischaemic stroke. ...
Background and aims
Patients with Moyamoya disease (MMD) can present with ischaemic or haemorrhagic stroke. There is no good evidence for treatment strategies in MMD-associated acute ischaemic stroke (AIS), particularly for treatments like intravenous thrombolysis (IVT) and endovascular thrombectomy (ET). As the intracranial vessels are friable in MMD, and the risk of bleeding is high, the use of IVT and ET is controversial. To clarify the safety and efficacy of IVT/ET in the treatment of MMD-associated AIS, we performed a systematic review and meta-summary to examine this issue.
Methods
A systematic search was performed from four electronic databases: PubMed (MEDLINE), Cochrane Library, EMBASE and Scopus, profiling data from inception till 21 November 2021, as well as, manually on Google Scholar.
Results
Ten case reports detailing 10 MMD patients presenting with AIS and undergoing IVT or ET, or both, were included in the analysis. The median National Institute of Health Stroke Scale score at presentation was 10 (Interquartile Range [IQR] = 6.0–16.5). IVT alone was instituted in 6 patients, primary ET was attempted in 2, and 2 had received bridging IVT with ET. Of the 4 patients who underwent ET, 2 patients achieved successful reperfusion (modified Thrombolysis In Cerebral Infarction scale [mTICI] ≥ 2b). In terms of functional outcomes, One patient achieved complete recovery (modified Rankin Scale 0), 4 patients attained improvement in neurological status, and 4 had no improvement, whilst functional outcome was unreported in 1 patient. No patient experienced symptomatic intracranial haemorrhage.
Conclusions
In this systematic review and meta-summary, the utility of IVT and ET in MMD-associated AIS appears feasible in selected cases. Further larger cohort studies are required to evaluate these treatment approaches.
Highlights
· AIS in MMD was typically managed with bypass surgery but not via thrombolysis or thrombectomy.
· In this meta-summary, all patients treated with thrombolysis and/or thrombectomy survived and some experienced symptomatic and/or functional improvement.
· Further larger cohort studies are necessary for investigating the role of thrombolysis and/or thrombectomy as treatment of AIS in MMD.
