Evaluation of angiographic changes of the anterior choroidal and posterior communicating arteries for predicting cerebrovascular lesions in adult moyamoya disease

To ascertain the relationship between angiographic changes of the anterior choroidal and posterior communicating arteries (AChA–PComA) and cerebrovascular lesions in adult patients with moyamoya disease (MMD), we reviewed cerebral angiograms from 132 adult patients with MMD (68 with ischemia and 64 with hemorrhage). The angiographic findings of the AChA–PComA in each symptomatic hemisphere were graded on a scale of 0 to 3. The data were statistically analyzed for correlation with cerebrovascular lesions. Extension with abnormal branches and excessive dilation of the AChA–PComA accounted for 28 of the hemorrhagic lesions (28/64, 43.8%), especially intraventricular hemorrhage (16/28, 57.1%; p < 0.001). Additionally, when the occlusion was proximal to the PComA of the internal carotid artery, the posterior circulation territory was susceptible to ischemic lesions or subarachnoid hemorrhage (SAH) (p < 0.001), particularly aneurysmal SAH (p < 0.001). The angiographic characteristics of AChA–PComA may predict the onset of certain cerebrovascular lesions in adult patients with MMD.