Article Figures & Data
Figures
- Fig 1.
A 48-year-old woman who presented with headache. A, There is high-grade stenosis of the main trunk of the right MCA with “puff of smoke” vessels in the region of the stenotic trunk. B, The left ICA and branches are normal. Angiography indicates a Suzuki grade II right hemisphere and a Suzuki grade 0 left hemisphere. The arrows indicate surface collaterals extending from the right ACA to the right MCA territory. C, The CVR map shows absence of reactivity to the CO2 stimulus (no color) in the right parietal lobe, corresponding to the region of the angiographic collaterals.
- Fig 2.
A 35-year-old woman who presented with TIA consisting of left hemiparesis. A−C, The angiograms indicate severe stenosis/occlusion of the distal ICAs bilaterally, with extensive Moyamoya vessels consistent with Suzuki grade IV bilaterally. The left vertebral injection (C) shows extensive pial collateralization from the posterior circulation to the ACA and MCA territories. However, the right hemisphere is not as well supplied as the left. D, This finding is supported by the CVR map, which shows a greater extent of steal phenomena (blue pixels) in the right hemisphere compared with the left. Notice the preservation of reactivity in the relatively well-supplied cerebellum.
- Fig 3.
Relationship between Mean CVRcombined versus disease severity as measured by the modified Suzuki score. A, Mean CVRcombined versus the Suzuki score for the MCA territory. B, Mean CVRcombined versus the Suzuki score for the ACA territory.
- Fig 4.
Correlation between Mean CVRcombined for MCA and ACA territories and the presence of pial or Moyamoya collaterals. M-P- indicates the absence of Moyamoya or pial collaterals, M+P− indicates the presence of Moyamoya collaterals but the absence of pial collaterals, and M+P+ indicates the presence of Moyamoya and pial collaterals.
- Fig 5.
Relationship between Mean CVRpos, Mean CVRcombined, Mean CVRneg, and the degree of vascular steal (fneg) for all ACA, MCA, and PCA territories. Closed circles represent vascular territories with a Suzuki score of 0, and open circles, Suzuki >0. A, Mean CVRpos versus fneg. B, Mean CVRcombined versus fneg. An exponential decay has been fitted to the data. The dotted lines indicate the 95% confidence band. C, Mean CVRneg versus fneg.
Tables
Clinical and angiographic characteristics of 11 patientsa
Case No. Age (yr) Sex Clinical Presentation Suzuki Collaterals ACA Collaterals MCA Collaterals PCA Left Right Left Right Left Right Left Right 1 48 F Headache 0 III 0 0 0 2 0 0 2 36 M Headache 0 III 0 0 0 2 0 0 3 45 M TIA (left weakness) II IV 2 2 0 2 0 0 4 39 F TIA (right weakness) II 0 0 0 2 0 0 0 5 33 F Headache II II 2 1 1 1 0 0 6 35 F TIA (left weakness) IV IV 2 2 1 1 1 1 7 44 M Right facial, arm numbness, slurred speech IV 0 0 0 2 0 0 0 8 41 M TIA (right weakness) IV III 0 1 2 2 0 0 9 10 F Asymptomatic IV 0 1 0 2 0 0 0 10 11 F TIA (right hand weakness) IV IV 2 2 2 2 0 0 11 33 F Asymptomatic III II 2 2 2 2 0 1 -
a 0 indicates no collaterals (M−P−); 1, Moyamoya collaterals only (M+P−); 2, pial and Moyamoya collaterals (M+P+).
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