Angioplasty for Acute Stroke With Pediatric Moyamoya Syndrome

Abstract

Moyamoya vasculopathy is a progressive, occlusive vasculopathy leading to ischemic and hemorrhagic strokes. No treatments are established to treat acute ischemic stroke with moyamoya vasculopathy. A 3-year-old girl with moyamoya syndrome developed acute left hemiplegia. Emergent angiography showed near-occlusion of the supraclinoid segment of the right internal carotid artery. Balloon angioplasty was performed within 6 hours of symptom onset, with significant improvement in the child’s neurological symptoms. This is the youngest case of intracranial balloon angioplasty, and this article discusses the paucity of data regarding angioplasty and other forms of endovascular intervention in pediatric cerebrovascular disease and moyamoya vasculopathy. Further study is needed to determine the safety and efficacy of endovascular intervention in these diseases.

Keywords

childhood stroke balloon angioplasty moyamoya syndrome

Get full access to this article

View all access options for this article.

References

Ezura M. , Yoshimoto T. , Fujiwara S. , Takahashi A. , Shirane R. , Mizoi K. Clinical and angiographic follow-up of childhood-onset moyamoya disease. Childs Nerv Syst. 1995;11(10):591-594.

Kurokawa T. , Tomita S. , Ueda K. , et al. Prognosis of occlusive disease of the circle of Willis (moyamoya disease) in children. Pediatr Neurol. 1985 ;1(5):274-277.

Scott RM , Smith JL , Robertson RL , Madsen JR , Soriano SG , Rockoff MA Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis. J Neurosurg. 2004;100(2 suppl pediatrics):142-149.

Choi JU , Kim DS , Kim EY , Lee KC Natural history of moyamoya disease: comparison of activity of daily living in surgery and non surgery groups. Clin Neurol Neurosurg. 1997;99(suppl 2): S11-S18.

Mathews MS , Sharma J. , Snyder KV , et al. Safety, effectiveness, and practicality of endovascular therapy within the first 3 hours of acute ischemic stroke onset. Neurosurgery. 2009;65(5): 860-865; ; discussion 865.

Mori T. , Fukuoka M. , Kazita K. , Mori K. Follow-up study after percutaneous transluminal cerebral angioplasty. Eur Radiol. 1998; 8(3):403-408.

Turan TN , Derdeyn CP , Fiorella D. , Chimowitz MI Treatment of atherosclerotic intracranial arterial stenosis. Stroke. 2009;40(6): 2257-2261.

Marks MP , Wojak JC , Al-Ali F. , et al. Angioplasty for symptomatic intracranial stenosis: clinical outcome. Stroke. 2006; 37(4):1016-1020.

Chimowitz MI , Lynn MJ , Howlett-Smith H. , et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med . 2005;352(13):1305-1316.

10.

Grigoriadis S. , Gomori JM , Grigoriadis N. , Cohen JE Clinically successful late recanalization of basilar artery occlusion in childhood: what are the odds? Case report and review of the literature. J Neurol Sci. 2007 ;260(1-2):256-260.

11.

Kirton A. , Wong JH , Mah J. , et al. Successful endovascular therapy for acute basilar thrombosis in an adolescent. Pediatrics. 2003; 112(3 pt 1):e248-e251.

12.

Cognard C. , Weill A. , Lindgren S. , Piotin M. , Castaings L. , Moret J. Basilar artery occlusion in a child: ‘‘clot angioplasty’’ followed by thrombolysis. Childs Nerv Syst. 2000;16(8):496-500.

13.

Zaidat OO , Tolbert M. , Smith TP , Alexander MJ Primary endovascular therapy with clot retrieval and balloon angioplasty for acute basilar artery occlusion. Pediatr Neurosurg. 2005;41(6):323-327.

14.

Drazin D. , Calayag M. , Gifford E. , Dalfino J. , Yamamoto J. , Boulos AS Endovascular treatment for moyamoya disease in a Caucasian twin with angioplasty and Wingspan stent. Clin Neurol Neurosurg. 2009;111(10):913-917.

15.

Kornblihtt LI , Cocorullo S. , Miranda C. , Lylyk P. , Heller PG , Molinas FC Moyamoya syndrome in an adolescent with essential thrombocythemia: successful intracranial carotid stent placement. Stroke. 2005;36(8):E71-E73.

16.

Rodriguez GJ , Kirmani JF , Ezzeddine MA , Qureshi AI Primary percutaneous transluminal angioplasty for early moyamoya disease. J Neuroimaging. 2007;17(1):48-53.