Association Between Champagne Bottle Neck Sign of Internal Carotid Artery and Ipsilateral Hemorrhagic Stroke in Patients with Moyamoya Disease

Objective: To assess association between champagne bottle neck sign (CBNS) in carotid artery and intracranial hemorrhage in patients with moyamoya disease (MMD).

Methods: This retrospective study included 76 consecutive patients with MMD without definite risk factors associated with intracranial hemorrhage who underwent preoperative angiography from January 2016 to December 2017. CBNS was defined as luminal diameter ratio of internal carotid artery/common carotid artery ≤0.5 on angiography. The right and left cerebral hemisphere in each patient was separately identified as hemorrhagic and nonhemorrhagic. Association between CBNS and intracranial hemorrhage was analyzed.

Results: Of 76 patients with MMD, intracranial hemorrhage was found in 44 of 152 (28.9%) hemispheres, and 6.8% (3/44) had multiple events. Comparing carotid arteries without intracranial hemorrhage in ipsilateral hemispheres, patients with intracranial hemorrhage in the ipsilateral hemisphere had significantly smaller luminal diameter ratio of internal carotid artery/common carotid artery (0.49 ± 0.11 vs. 0.55 ± 0.12, P < 0.01) and higher prevalence of CBNS (63.7% vs. 41.7%, P = 0.01). Comparing hemispheres with intracranial hemorrhage, patients with ipsilateral carotid artery CBNS had significantly higher prevalence of hemorrhage in posterior territories than patients without CBNS (57.1% vs. 23.1%, P = 0.05). Logistic regression revealed that CBNS was significantly associated with ipsilateral intracranial hemorrhage before (odds ratio = 2.45; 95% confidence interval, 1.19-5.05; P = 0.02) and after (odds ratio = 3.43; 95% confidence interval, 1.50-7.87; P < 0.01) adjusting for female sex, lenticulostriate anastomosis, and choroidal anastomosis.

Conclusions: CBNS is significantly associated with intracranial hemorrhage in the ipsilateral hemisphere in patients with MMD, particularly intracranial hemorrhage in posterior territories.