Abstract TP83: Impaired Cerebrovascular Reactivity to Acetazolamide in Parent Arterial Territory of Major Artery Aneurysms in Adult Patients with Moyamoya Disease
Bibliographic record
Abstract
Background— Recent studies have suggested that haemodynamic stress probably induces the formation of major artery aneurysms around the circle of Willis in adult patients with moyamoya disease (MMD). Theoretically, cerebrovascular reactivity (CVR) to acetazolamide (ACZ) is gradually reduced in the conditions that cerebral perfusion pressure is decreased. If arterial narrowing progress, CVR to ACZ would be reduced (Kuroda’s Type 2 or 3 ischemia) in the parent arterial territory of these aneurysms owing to elevated cerebrovascular resistance. This study was aimed to test the hypothesis whether the CVR to ACZ is reduced in the parent arterial territory of the major artery aneurysms. Methods— This retrospective study included 172 adult patients with MMD diagnosed at our institutes between 1980 and 2011. Eight major artery aneurysms was found in 7 (4.1%) of these patients, including 5 women and 3 men at the mean age of 47.4 years. Aneurysm location and perfusion territory of the parent artery were determined on digital subtraction angiography. Regional cerebral blood flow (CBF) was quantitatively measured, using 123 I-IMP SPECT. Subsequently, ACZ was intravenously injected to determine the reactivity of CBF. CVR to ACZ in the parent arterial territory was calculated (n=8). CVR in the contralateral arterial territory of the parent artery was utilized as a control (n=6). Results— Four (50%) of 8 major artery aneurysms were located in the vertebrobasilar system. All aneurysms were saccular and small, ranging from 2.0 and 5.0 mm. CVR to ACZ were reduced in 5 (62.5%) of 8 parent arterial territory (Type 2 or 3). All the contralateral arterial territory of the parent artery had normal CBF and CVR to ACZ (Type 1). Compared with contralateral side (32.0 ± 10.7%), CVR to ACZ was not significantly reduced in the parent artery side (16.5 ± 19.0%, P=0.11; paired-t). Fisher’s exact test, however, demonstrated a significant association between the existence of major artery aneurysms and reduced CVR to ACZ in the parent arterial territory (P=0.03). Conclusions— These findings suggest that reduced CVR in the parent arterial territory of the major artery aneurysms indicates underlying hemodynamic vascular stress inducing aneurysm formation in adult patients with MMD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".