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논문 기본 정보

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학술저널
저자정보
Jae Youn Kim (Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Kor) Hyung Jun Kim (Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Kor) 최은혁 (성균관대학교 의과대학 삼성서울병원 신경과) Kwang Hyun Pan (Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Kor) Jong-Won Chung (Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Kor) Woo-Keun Seo (Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Kor) Gyeong-Moon Kim (Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Kor) Tae Keun Jee (Department of Neurosurgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul) Je Young Yeon (Department of Neurosurgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul) Jong-Soo Kim (Department of Neurosurgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul) Seung-Chyul Hong (Department of Neurosurgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul) 성민정 (성균관대학교 의과대학 삼성서울병원 영상의학과) Jihoon Cha (Department of Radiology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Kor) Keon Ha Kim (Department of Radiology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Kor) 전평 (독립연구자) Oh Young Bang (Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Kor)
저널정보
대한신경과학회 Journal of Clinical Neurology Journal of Clinical Neurology 제18권 제6호
발행연도
2022.11
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610 - 618 (9page)

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Background and Purpose The natural course of adult-onset moyamoya disease (MMD) is unknown, and there is no medical treatment that halts its progression. We hypothesized that progressive shrinkage of large intracranial arteries occurs in adult-onset MMD, and that cilostazol inhibits this process. Methods Serial high-resolution magnetic resonance imaging (HR-MRI) was performed on 66 patients with MMD: 30 patients received cilostazol, 21 received other antiplatelets, and 15 received no antiplatelets or had poor compliance to them. Serial HR-MRI was performed (interval between MRI scans: 29.67±18.02 months, mean±SD), and changes in outer diameter, luminal stenosis, and vascular enhancement were measured. Factors affecting HR-MRI changes were evaluated, including vascular risk factors and the ring finger protein 213 gene variant. Results The progression of stenosis to occlusion, recurrent ischemic stroke, and the development of new stenotic segments were observed in seven, seven, and three patients, respectively. Serial HR-MRI indicated that the degree of stenosis increased with negative remodeling (outer diameter shrinkage). Patients who received cilostazol presented significantly larger outer diameters and lower degrees of stenosis compared with other groups (p=0.005 and p=0.031, respectively). After adjusting for clinical and genetic factors, only cilostazol use was independently associated with negative remodeling (odds ratio=0.29, 95% confidence interval=0.10–0.84, p=0.023). While vascular enhancement was observed in most patients (61 patients), the progression of enhancement or the occurrence of new vascular enhancement was rarely observed on follow-up HR-MRI (6 and 1 patients, respectively). Conclusions Adult-onset MMD induces progressive shrinkage of large intracranial arteries, which cilostazol treatment may prevent. Further randomized clinical trials are warranted.
#moyamoya disease #intracranial stenosis #magnetic resonance imaging #stroke #cilostazol

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