To describe profiles of collateral arteries of moyamoya disease (MMD) and analyze risk factors of cerebral hemorrhagic events.

This study retrospectively analyzed 298 patients diagnosed with MMD at Tiantan Hospital in Beijing, who were divided into pediatric and adult groups. Angiographic features were compared between groups. Angiographic outcomes were assessed between hemispheres with and without cerebral hemorrhagic events in adult and pediatric groups separately. Logistic regression analysis was performed to identify relevant risk factors of cerebral hemorrhage.

Among 298 patients, there were 20 hemorrhagic hemispheres in the pediatric group and 106 hemorrhagic hemispheres in the adult group. The superficial temporal artery and middle meningeal artery (MMA) were more prominent in the adult group than in the pediatric group. In the pediatric group, the superficial temporal artery, MMA, posterior choroidal artery, and middle cerebral artery were more prominent in hemorrhagic hemispheres than in ischemic hemispheres. In the adult group, the superficial temporal artery, MMA, and middle cerebral artery were more prominent in hemorrhagic hemispheres than in ischemic hemispheres. Logistic regression analysis showed that presence of the posterior choroidal artery was associated with cerebral hemorrhagic events in pediatric patients with MMD. Disappearance of ophthalmic artery, presence of MMA, and presence of MCA were associated with cerebral hemorrhagic events in adult patients with MMD.

Differences in collateral arteries between adult patients with MMD and pediatric patients with MMD were observed, among which MMA acted as a predictor for cerebral hemorrhage in adult patients with MMD.

Cerebral hemorrhage

Collateral vessel

Hemorrhagic stroke

Moyamoya disease

Vascular anatomy

Anterior choroidal artery

Digital subtraction angiography

external carotid artery

Intracerebral hemorrhage

Middle cerebral artery

Middle meningeal artery

Posterior choroidal artery

Superficial temporal artery

© 2025 The Authors. Published by Elsevier Inc.