Angiographic and clinical outcomes of non-patent anastomosis after bypass surgery in adult moyamoya disease

Kim, Seunghwan; Lee, Hyungon; Yoo, Minwook; Jin, Seongjin; Lee, Sungjoon; Choi, Byoung‐Joo; Kim, Hae Yu; Jin, Sung-Chul

doi:10.1007/s00701-018-3733-3

Cited by 16 publications

(17 citation statements)

References 12 publications

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“…It was noteworthy that although the anastomosis was occluded, two hemispheres treated with DB+EDAS still achieved Matsushima level B. Likewise, Kim et al also demonstrated that clinical improvement of non-patent anastomosis can be expected after bypass surgery for adult MMD (20).…”

Section: Discussionmentioning

confidence: 98%

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Angiographic Outcomes of Direct and Combined Bypass Surgery in Moyamoya Disease

Liu

et al. 2019

Front. Neurol.

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Objective: To identify associated risk factors for the angiographic outcomes after direct and combined bypass surgery in moyamoya disease (MMD).Methods: All direct and combined bypass procedures performed from June 2009 to May 2015 were screened in this prospective cohort study. Patients who acquired presurgical and follow-up catheter angiography were included. Bypass patency and postoperative collateral formation were evaluated. Univariate and multivariate logistic regression analyses were performed to determine the influence factors for bypass patency and postoperative collateral formation.Results: In total, 188 consecutive bypass procedures were included. After an 18-month median follow-up, the anastomosis patency rate was 88.3%. Postoperative collateral formation was associated with the patency of the anastomosis (Gamma = 0.891, p < 0.001). Multivariate logistic regression analysis showed that presence of hemorrhage (OR, 0.298; 95% CI, 0.125–0.709; p = 0.006) was associated with obstructed anastomosis. Among the 188 bypass surgeries, 125 (63.2%) hemispheres had good postoperative collateral formation and 85 (36.8%) had poor postoperative collateral formation. Multivariate logistic regression analysis showed that younger age at operation (OR, 2.396; 95% CI, 1.231–4.664; p = 0.010) was associated with good postoperative collateral formation, while the poor postoperative collateral formation was related to presence of hemorrhage (OR, 0.329; 95% CI, 0.143–0.758; p = 0.009) and dilated anterior choroidal artery (OR, 0.472; 95% CI, 0.240–0.929; p = 0.030).Conclusions: This study has demonstrated that presence of hemorrhage predicts lower patency rates. Younger age at operation was associated with good postoperative collateral formation, while the poor postoperative collateral formation was related to presence of hemorrhage and dilated anterior choroidal artery.

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Section: Discussionmentioning

confidence: 98%

“…Bypass patency is an important determinant factor to evaluate the success of the surgery and the long-term outcome of the patient (8, 11, 20). Although the primary bypass function has been evaluated during surgery, there is a 4–10% chance of early bypass failure (21).…”

Section: Discussionmentioning

confidence: 99%

Angiographic Outcomes of Direct and Combined Bypass Surgery in Moyamoya Disease

Liu

et al. 2019

Front. Neurol.

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“…reported a patient in which intraoperative bypass obstruction was confirmed, similar to our case. [ 3 ] Furthermore, in our case, there was no massive cerebral infarction that caused irreversible neurological symptoms after surgery despite occlusion of the recipient artery, which is considered to be the only site of craniotomy. It is considered that this is due to the well-developed leptomeningeal collateral circulation in patients with moyamoya disease.…”

Section: Discussionmentioning

confidence: 59%

“…However, we focused on the fact that they note in the article that in patients with advanced moyamoya disease, such as Suzuki Grade 4, the recipient artery is often nearly occluded as well as fragile, which may cause failure of anastomosis. [ 3 ] The patient described in the present article also had advanced moyamoya disease, reflected by Suzuki Grade 4. From our experience, we agree that recipient vessels in advanced moyamoya disease are poorer and selecting appropriate recipients are difficult.…”

Section: Discussionmentioning

confidence: 69%

“…In their series, there were 11 nonpatent anastomoses in 31 cases they operated. [ 3 ] It should be noted that that the nonpatency rate in that series was quite high, which they considered to be due to their lack of experience. However, we focused on the fact that they note in the article that in patients with advanced moyamoya disease, such as Suzuki Grade 4, the recipient artery is often nearly occluded as well as fragile, which may cause failure of anastomosis.…”

Section: Discussionmentioning

confidence: 94%

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Delayed reopening of a superficial temporal artery to middle cerebral artery bypass graft occluded by a white thrombus during surgery

Takahashi

Yoshida

2020

Surgical Neurology International

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Background: To the authors’ knowledge, reopening of a superficial temporal artery to middle cerebral artery (STA-MCA) bypass graft occluded by a white thrombus during the procedure and was observed several months after the surgery is relatively rare. Case Description: The authors encountered a case of moyamoya disease in an Asian female in her third decade of life, in whom a bypass recipient vessel was occluded by a white thrombus during surgery and remained occluded on magnetic resonance angiography (MRA) performed up to 6 weeks after the procedure. However, recanalization was confirmed by MRA performed 4 months after surgery. MRA performed 10 and 19 months after surgery revealed that the bypass vessel had grown thicker, and the ischemic symptoms experienced by the patient also improved. Conclusion: Whether this lesion is explained by reopening or angiogenesis, its pathophysiology remains controversial. The uninterrupted connection of occluded bypass vessel in STA-MCA bypass surgery in conjunction with surgical strategy of single bypass using only parietal branch of STA as donor and preserving blood flow of frontal branch to scalp may have made a positive impact on promoting the development of extracranial-intracranial bypass anastomosis in the chronic phase and should be considered.

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