diffuse proliferative cerebral arterial disord.PPTVIP

Moyamoya: Vascular MR Different patients: MRA shows stenosis of both MCAs large perforators (left). Center shows stenosis of left MCA. MR perfusion (right) shows low rCBF in deep regions of both hemispheres. Treatment Cerebral Proliferative Angiopathy Moyamoya Targeted embolization Increase cortical blood supply: Synangiogenesis or calvarial burr holes increase cortical blood supply by recruiting additional dural arteries Antiplatelet Tx Calcium channel blockers Surgery: Synangiogenesis or calvarial burr holes Bypass ECA to ischemic zone is feasible Hemorrhagic Angiopathy: Response to Radiation therapy Pre Post radiation Tx angiography performed on hemorrhagic angiopathy pts. Pre images demonstrate pseudo tumoral blush at time of ICH with rapid capillary transity. Post Tx images show excellent response to irradiation. Pre Treatment Post Treatment Pre Treatment Post Treatment Conclusions Both cerebral proliferative angiopathy Moyamoya are arterial proliferative conditions leading to stenoses in proximal vessels. Both are ischemic arterial conditions. Proliferative angiopathy and hemorrhagic angiopathy have to be considered as a group of disorders different from classical brain AVMs. Conclusions Treatment of Moyamoya aims to an improvement in arterial supply by direct (bypass) or indirect (synangiogenesis or calvarial burr holes) revascularization techniques. Proliferative angiopathy pts. can be candidates for arterial revascularisation treatments. In some instances they can benefit from targeted embolizations. Hemorrhagic angiopathy has a rapid response to the radiotherapy. References Scott R. et al. Moyamoya Disease and Moyamoya Syndrome. NEJM 2009;360:1226-37. Bacigaluppi S, Dehdashti AR, Agid R, Krings T, Tymianski M, Mikulis DJ.Neurosurg The contribution of imaging in diagnosis, preoperative assessment, and follow-up of moyamoya disease: a review. Neurosurg Focus. 2009; 26:E3a Lasjaunias P. et al. Cerebral Proliferative Angiopathy, Clinical and A