Angiographic Outcomes of Direct and Combined Bypass Surgery in Moyamoya Disease

Ge, Peicong; Ye, Xun; Liu, Xingju; Deng, Xiaofeng; Jia, Wang; Wang, Rong; Zhang, Yan; Zhang, Dong; Zhang, Qian; Zhao, Jizong

doi:10.3389/fneur.2019.01267

Cited by 23 publications

(30 citation statements)

References 32 publications

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“…Overall definite bypass patency after 6 to 12 months was excellent with 98.1% and, therefore, slightly higher than reported in the literature (3,4). One bypass which was confirmed to be occluded in the follow-up DSA was already displayed as non-patent in the post-operative CTA.…”

Section: Discussionmentioning

confidence: 52%

“…Surgical revascularization with direct extracranial-intracranial (EC-IC) bypass is the most common therapy in adult moyamoya patients (1,2). Long-term bypass patency has been shown to be between 88 and 97% in these patients (3)(4)(5)(6). The risk of bypass occlusion appears highest during the first week after surgery and declines over time as the bypass matures (3).…”

Section: Introductionmentioning

confidence: 99%

“…Digital subtraction angiography (DSA) is the "gold standard" for the imaging of cerebral vessels (3,4,7,8). However, noninvasive techniques, such as computed tomography angiography (CTA) or time-of-flight magnetic resonance angiography (MR-TOF) can also be used to examine the cerebral vessels with high precision (9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

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Early Post-operative CT-Angiography Imaging After EC-IC Bypass Surgery in Moyamoya Patients

Hurth¹,

Hauser²,

Haas³

et al. 2021

Front. Neurol.

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Objective: To evaluate the clinical value of early post-operative computed tomographic angiography (CTA) after direct extracranial-intracranial (EC-IC) bypass surgery in moyamoya patients.Methods: A retrospective analysis of all adult moyamoya patients treated at our center from 2013 to 2019 with a direct EC-IC bypass was performed. Early post-operative CTA (within 24 h after surgery) was compared with conventional digital subtraction angiography (DSA) 6–12 months after surgery. If available, magnetic resonance time-of-flight angiography (MR-TOF) was evaluated 3 months and 6–12 months post-operatively as well. Imaging results were analyzed and compared with CTA, MR-TOF and DSA, whereat DSA was used as the final and definite modality to decide on bypass patency.Results: A total of 103 direct EC-IC bypasses in 63 moyamoya patients were analyzed. All inclusion criteria were met in 32 patients (53 direct bypasses). In 84.9% the bypass appeared definitively, in 5.7% uncertainly and in 9.4% not patent according to early post-operative CTA. MR-TOF suggested definitive bypass patency in 86.8% 3 months after surgery and in 93.5% 6–12 months after surgery. DSA 6–12 months post-operatively showed a patency in 98.1% of all bypasses. The positive predictive value (to correctly detect an occluded bypass) on post-operative CTA was 12.5%, the negative predictive value (to correctly detect a patent bypass) was 100% with a sensitivity of 100% and a specificity of 86.5%.Conclusion: Early post-operative CTA has a high predictive value to confirm the patency of a bypass. On the other hand, a high false positive rate of (according to CTA) occluded bypasses after direct EC-IC bypass surgery can be seen. This must be considered critically when initiating possible therapeutic measures.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Early Post-operative CT-Angiography Imaging After EC-IC Bypass Surgery in Moyamoya Patients

Hurth¹,

Hauser²,

Haas³

et al. 2021

Front. Neurol.

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“…Direct revascularization is currently recognized as the superior treatment paradigm for adult hemorrhagic MMD to reduce the incidence of rebleeding [ 9 , 10 , 20 ]. However, hemorrhagic MMD was indicated to be more prone to delayed anastomotic occlusion compared with ischemic MMD, with a long-term graft patency rate of 54.9–77.5% [ 12 , 13 ]. Such a high rate of anastomotic occlusion prompted us to conduct in-depth research on the mechanism of delayed anastomotic occlusion and its impact on the long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, direct or combined revascularization has been recognized as the most effective treatment strategy to reduce the risk of future intracranial hemorrhages in hemorrhagic MMD [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. However, Zhao et al and Ge et al, from our institution, demonstrated that hemorrhagic presentation predicts lower patency rates (54.9–77.5%) and unsatisfactory neoangiogenesis after direct/combined bypass [ 12 , 13 ]. Such a high rate of delayed anastomotic occlusion prompted us to conduct an in-depth analysis of this phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Delayed Anastomotic Occlusion after Direct Revascularization in Adult Hemorrhagic Moyamoya Disease

et al. 2021

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Delayed anastomotic occlusion occurred in a considerable proportion of hemorrhagic moyamoya disease (MMD) patients undergoing direct revascularization. This study aimed to investigate the predictors and outcomes of delayed anastomotic occlusion in adult hemorrhagic MMD. The authors retrospectively reviewed 87 adult hemorrhagic MMD patients. Univariate and multivariate logistic regression analyses were performed. After an average of 9.1 ± 6.9 months of angiographic follow-up, the long-term graft patency rates were 79.8%. The occluded group had significantly worse angiogenesis than the non-occluded group (p < 0.001). However, the improvement of dilated anterior choroidal artery–posterior communicating artery was similar (p = 0.090). After an average of 4.0 ± 2.5 years of clinical follow-up, the neurological statues and postoperative annualized rupture risk were similar between the occluded and non-occluded groups (p = 0.750; p = 0.679; respectively). In the multivariate logistic regression analysis, collateral circulation Grade III (OR, 4.772; 95% CI, 1.184–19.230; p = 0.028) and preoperative computed tomography perfusion (CTP) Grade I–II (OR, 4.129; 95% CI, 1.294–13.175; p = 0.017) were independent predictors of delayed anastomotic occlusion. Delayed anastomotic occlusion in adult hemorrhagic MMD might be a benign phenomenon. Good collateral circulation (Grade III) and compensable preoperative intracranial perfusion (CTP Grade I–II) are independent predictors for this phenomenon. Moreover, the delayed anastomotic occlusion has no significant correlations with the long-term angiographic and neurological outcomes, except neoangiogenesis.

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A novel intraoperative “Faucet” technique for assessing patency of superficial temporal artery to middle cerebral artery bypass and for prevention of microemboli

Nurimanov,

Menlibayeva

2024

Acta Neurochir

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Purpose This technical note introduces the novel faucet technique, which enables neurosurgeons to evaluate the patency of a bypass during superficial temporal artery–middle cerebral artery bypass surgery. The technique is particularly useful when there is a lack of equipment such as micro-Doppler or indocyanine green in the operating rooms. This is often the case in Central Asian countries. Methods The faucet technique involves carefully examining the graft by gently opening a valve, comparable to a faucet, to observe the blood flow through the bypassed vessel. Overall, 36 procedures underwent the faucet technique for assessing the superficial temporal artery–middle cerebral artery bypass patency. Results The results indicate that the bypass remained patent in all cases, as confirmed through the intraoperative faucet technique, postoperative magnetic resonance angiography, or cerebral angiography. Conclusion By visually inspecting the blood flow through the faucet technique, surgeons can confirm the effectiveness of the graft and ensure that the bypass remains unobstructed during the surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-024-06305-6.

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Angiographic Outcomes of Direct and Combined Bypass Surgery in Moyamoya Disease

Cited by 23 publications

References 32 publications

Early Post-operative CT-Angiography Imaging After EC-IC Bypass Surgery in Moyamoya Patients

Early Post-operative CT-Angiography Imaging After EC-IC Bypass Surgery in Moyamoya Patients

Delayed Anastomotic Occlusion after Direct Revascularization in Adult Hemorrhagic Moyamoya Disease

A novel intraoperative “Faucet” technique for assessing patency of superficial temporal artery to middle cerebral artery bypass and for prevention of microemboli

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