PT - JOURNAL ARTICLE AU - T. Funaki AU - A. Miyakoshi AU - H. Kataoka AU - J.C. Takahashi AU - Y. Takagi AU - K. Yoshida AU - T. Kikuchi AU - Y. Mineharu AU - M. Okawa AU - Y. Yamao AU - Y. Fushimi AU - S. Miyamoto TI - Larger Posterior Revascularization Associated with Reduction of Choroidal Anastomosis in Moyamoya Disease: A Quantitative Angiographic Analysis AID - 10.3174/ajnr.A7609 DP - 2022 Sep 01 TA - American Journal of Neuroradiology PG - 1279--1285 VI - 43 IP - 9 4099 - http://www.ajnr.org/content/43/9/1279.short 4100 - http://www.ajnr.org/content/43/9/1279.full SO - Am. J. Neuroradiol.2022 Sep 01; 43 AB - BACKGROUND AND PURPOSE: Choroidal anastomosis, a hemorrhage-prone periventricular collateral manifestation in Moyamoya disease, outflows to the cortex posterior to the central sulcus. The objective of the present study was to test whether the angiographic extent of revascularization posterior to the central sulcus contributes to the postoperative reduction of choroidal anastomosis.MATERIALS AND METHODS: This retrospective cohort study included choroidal anastomosis–positive hemispheres before direct bypass surgery. The postoperative reduction of choroidal anastomosis was determined by a consensus of 2 raters according to the previous research. An imaging software automatically traced the angiographic revascularization area, which was subsequently divided into anterior and posterior parts by an anatomic line corresponding to the central sulcus. Each area was quantitatively measured as a percentage relative to the whole supratentorial area.RESULTS: Postoperative reduction of choroidal anastomosis was achieved in 68 (85.0%) of the 80 included hemispheres. The revascularization area posterior to the central sulcus was significantly larger in the hemispheres with reduction than in those with no reduction (mean, 15.2% [SD, 7.1%] versus 4.2% [SD, 3.4%], P < .001), whereas no significant difference was observed in the revascularization area anterior to the central sulcus. Multivariate analysis revealed that the revascularization area posterior to the central sulcus was the only significant factor associated with reduction (OR, 1.57; 95% CI, 1.21–2.03, for every 1% increase).CONCLUSIONS: The results suggest that a larger revascularization posterior to the central sulcus is associated with postoperative reduction of choroidal anastomosis regardless of the extent of anterior revascularization. It might facilitate optimal selection of the revascularization site for preventing hemorrhage.CScentral sulcusPCAposterior cerebral arterySTAsuperficial temporal artery