{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:15:53Z","timestamp":1785888953806,"version":"3.56.0"},"reference-count":62,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Choroidal anastomosis (ChA) is considered a key indicator of increased hemorrhagic risk in adult moyamoya disease (MMD); however, its clinical course remains unclear. The aim of this study was to identify potential predictors of ChA rupture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Retrospective evaluation of clinical and radiological data from 132 ChA-positive hemispheres (86 patients with MMD) treated at a single institution from March 2019 to March 2024 was conducted on a hemisphere-by-hemisphere basis. Two independent raters investigated the morphological characteristics of the ChA, including the lumen area (LA), branching pattern, and presence of a ChA-related pseudoaneurysm, using high-resolution vessel wall imaging. The primary endpoint was subsequent ChA-related hemorrhage, indicating ChA rupture. The secondary endpoint was any hemorrhagic stroke. A multivariate Cox proportional hazards model was used to evaluate the predictors of each endpoint.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Thirteen hemorrhagic strokes occurred in 12 hemispheres (12 patients) during a mean follow-up period of 35.2 months. Nine ChA-related hemorrhages were observed in 9 hemispheres. The predictors for ChA rupture (primary endpoint) were LA of the ChA (per 1-mm\n                      <jats:sup>2<\/jats:sup>\n                      increase; HR 36.4, 95% CI 4.50\u2013294; p = 0.001), complex-type ChA (HR 4.64, 95% CI 1.08\u201319.9; p = 0.039), ChA-related pseudoaneurysm (HR 31.6, 95% CI 2.10\u2013474; p = 0.013), and revascularization surgery (HR 0.12, 95% CI 0.02\u20130.79; p = 0.028). The predictors for any hemorrhagic stroke (secondary endpoint) were hemorrhagic presentation (HR 4.86, 95% CI 1.20\u201319.6; p = 0.026), LA of the ChA (per 1-mm\n                      <jats:sup>2<\/jats:sup>\n                      increase; HR 24.9, 95% CI 3.43\u2013180; p = 0.001), complex-type ChA (HR 4.42, 95% CI 1.19\u201316.3; p = 0.026), ChA-related pseudoaneurysm (HR 46.3, 95% CI 4.94\u2013433; p = 0.001), and revascularization surgery (HR 0.14, 95% CI 0.03\u20130.64; p = 0.012).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In ChA-positive hemispheres, a larger LA of the ChA, complex-type ChA, and the presence of ChA-related pseudoaneurysms were significant predictors of subsequent ChA rupture and hemorrhagic stroke, whereas revascularization surgery can reduce the risk of subsequent ChA rupture and hemorrhagic events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.jns251243","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:18Z","timestamp":1769083218000},"page":"1064-1074","source":"Crossref","is-referenced-by-count":1,"title":["Morphological characteristics of choroidal anastomosis as predictors of subsequent rupture in adult moyamoya disease: a longitudinal study using vessel wall imaging"],"prefix":"10.3171","volume":"144","author":[{"given":"Jiwook","family":"Ryu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung Mi","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho Geol","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju In","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Kyu","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bong Jin","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seok Keun","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Arch Neurol","first-page":"288","article-title":"Cerebrovascular moyamoya disease: disease showing abnormal net-like vessels in base of brain","volume":"20","author":"Suzuki J","year":"1969","unstructured":"Suzuki J, Takaku A. Cerebrovascular moyamoya disease: disease showing abnormal net-like vessels in base of brain. Arch Neurol. 1969;20(3):288\u2013299."},{"issue":"10","key":"b2","series-title":"Stroke","first-page":"e465","article-title":"Adult moyamoya disease and syndrome: current perspectives and future directions: a scientific statement from the American Heart Association\/American Stroke Association","volume":"54","author":"Gonzalez NR","year":"2023","unstructured":"Gonzalez NR, Amin-Hanjani S, Bang OY,  Adult moyamoya disease and syndrome: current perspectives and future directions: a scientific statement from the American Heart Association\/American Stroke Association. Stroke. 2023;54(10):e465\u2013e479.."},{"issue":"12","key":"b3","series-title":"Stroke","first-page":"2513","article-title":"A clinical comparison of definite moyamoya disease between South Korea and Japan","volume":"28","author":"Ikezaki K","year":"1997","unstructured":"Ikezaki K, Han DH, Kawano T, Kinukawa N, Fukui M. A clinical comparison of definite moyamoya disease between South Korea and Japan. Stroke. 1997;28(12):2513\u20132517."},{"issue":"3","key":"b4","series-title":"Neurol Med Chir (Tokyo)","first-page":"204","article-title":"Visualization of periventricular collaterals in moyamoya disease with flow-sensitive black-blood magnetic resonance angiography: preliminary experience","volume":"55","author":"Funaki T","year":"2015","unstructured":"Funaki T, Fushimi Y, Takahashi JC,  Visualization of periventricular collaterals in moyamoya disease with flow-sensitive black-blood magnetic resonance angiography: preliminary experience. 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Morphologic differences between ruptured and unruptured choroidal anastomosis in adult moyamoya disease: a high-resolution vessel wall imaging study. J Neurosurg. 2024;140(2):441\u2013449."},{"issue":"9","key":"b11","series-title":"AJNR Am J Neuroradiol","first-page":"1279","article-title":"Larger posterior revascularization associated with reduction of choroidal anastomosis in moyamoya disease: a quantitative angiographic analysis","volume":"43","author":"Funaki T","year":"2022","unstructured":"Funaki T, Miyakoshi A, Kataoka H,  Larger posterior revascularization associated with reduction of choroidal anastomosis in moyamoya disease: a quantitative angiographic analysis. 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