Contralateral improvement of cerebrovascular reactivity and TIA frequency after unilateral revascularization surgery in moyamoya vasculopathy

Deckers, Pieter T.; Hoek, Wytse van; Kronenburg, Annick; Yaqub, Maqsood; Siero, Jeroen C.W.; Bhogal, Alex A.; Berckel, Bart N.M. van; Zwan, Albert van der; Braun, Kees P.J.

doi:10.1016/j.nicl.2021.102684

Cited by 12 publications

(11 citation statements)

References 30 publications

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“…A possible explanation could be the initiation of perioperative medications (67). In addition, established patency on one side may reduce the collateral demand from the other, restoring contralateral ocular perfusion, as indicated in cerebral revascularization (68,69).…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Management of Ocular Ischemia in Takayasu’s Arteritis: A Case-Based Systematic Review

Zeng

Duan

et al. 2022

Front. Immunol.

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BackgroundTakayasu’s arteritis (TA) is a rare, chronic granulomatous large-vessel vasculitis that can lead to ocular ischemia. Ocular outcomes after therapeutic management in TA remain largely unknown. We herein conduct a case-based systematic review to address the current treatment options in this particular cohort.MethodsPubMed, Medline, and EMBASE databases were searched pertaining to ocular outcomes after systemic treatment in TA. Studies reporting ocular examinations before and after treatment in TA patients with ocular ischemia were included. Clinical characteristics, therapies, ocular outcomes, and complications were recorded.ResultsA 29-year-old woman with newly diagnosed TA showed dramatic regression of Takayasu’s retinopathy (TR) following balloon angioplasty. Optical coherence tomography angiography (OCTA) was used as a novel strategy for subsequent follow-up. A total of 117 eyes of 66 patients with a median age of 27 years were included for systematic review. TR was the most common ocular manifestation. Oral steroids were prescribed in nearly all patients (n = 65), followed by the use of methotrexate and antiplatelet therapy. Of the patients, 65.8% and 34.2% underwent open surgery and endovascular procedure, respectively. The median follow-up period was 12 weeks (interquartile range 8–33.5). Surgical therapy showed better ocular improvement (including visual and imaging responses) in both acute and chronic vision loss, along with fewer complications than medical therapy alone. In the surgical group, the visual prognosis was significantly better in patients with initial visual acuity better than 20/200 (p = 0.03) and those who underwent surgery before stage III TR (p = 0.01). Ocular outcomes were equivalent in the two surgical approaches.ConclusionClinicians should be familiar with ophthalmic manifestations of this potentially treatable complication in TA. Compared with medical therapy alone, surgical intervention might be a better choice for both acute and chronic vision loss. Surgery is best recommended before the onset of irreversible ischemia to the globe. A combined regimen (oral steroids, immunosuppressants, and antiplatelet drugs) might be effective for those with surgical contradictions or reluctance to an invasive procedure. Physicians should be aware of the importance of ocular examinations, including OCTA, during the diagnosis and follow-up in TA.

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Section: Discussionmentioning

confidence: 99%

Therapeutic Management of Ocular Ischemia in Takayasu’s Arteritis: A Case-Based Systematic Review

Zeng

Duan

et al. 2022

Front. Immunol.

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“…Studies have shown a significant CVR impairment in patients with MMD, based on ASL MRI and PET measurements following the injection of vasodilator acetazolamide ( Deckers et al, 2021 ; Zhao et al, 2022 ). These studies showed that the CBF of patients with MMD did not increase after the injection of acetazolamide, suggesting that the cerebral vessels were already at maximal vasodilation to compensate for CBF reduction.…”

Section: Vascular Smooth Muscle Cell Dysfunction and Cerebrovascular ...mentioning

confidence: 99%

“… Heyn et al (2010) also identified decreased regional CVR in patients with MMD using CO 2 BOLD MRI. Interestingly, unilateral surgical revascularization, a widely used preventative treatment for MMD, was found to improve PET-derived CVR in MMD patients not only in the hemisphere ipsilateral to the flow restoration, but also in the non-intervened hemisphere ( Sam et al, 2015 ; Deckers et al, 2021 ). It remains that more research is required to better understand how and at what stage VSMC dysfunction may contribute to MMD development and progression.…”

Section: Vascular Smooth Muscle Cell Dysfunction and Cerebrovascular ...mentioning

confidence: 99%

Vascular smooth muscle cell dysfunction in neurodegeneration

Hayes

Pinto²,

Sparks³

et al. 2022

Front. Neurosci.

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Vascular smooth muscle cells (VSMCs) are the key moderators of cerebrovascular dynamics in response to the brain’s oxygen and nutrient demands. Crucially, VSMCs may provide a sensitive biomarker for neurodegenerative pathologies where vasculature is compromised. An increasing body of research suggests that VSMCs have remarkable plasticity and their pathophysiology may play a key role in the complex process of neurodegeneration. Furthermore, extrinsic risk factors, including environmental conditions and traumatic events can impact vascular function through changes in VSMC morphology. VSMC dysfunction can be characterised at the molecular level both preclinically, and clinically ex vivo. However the identification of VSMC dysfunction in living individuals is important to understand changes in vascular function at the onset and progression of neurological disorders such as dementia, Alzheimer’s disease, and Parkinson’s disease. A promising technique to identify changes in the state of cerebral smooth muscle is cerebrovascular reactivity (CVR) which reflects the intrinsic dynamic response of blood vessels in the brain to vasoactive stimuli in order to modulate regional cerebral blood flow (CBF). In this work, we review the role of VSMCs in the most common neurodegenerative disorders and identify physiological systems that may contribute to VSMC dysfunction. The evidence collected here identifies VSMC dysfunction as a strong candidate for novel therapeutics to combat the development and progression of neurodegeneration, and highlights the need for more research on the role of VSMCs and cerebrovascular dynamics in healthy and diseased states.

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“…According to imaging examinations performed before the second revascularization surgery, cerebral blood flow and cerebral perfusion had improved to varying degrees in most postoperative hemispheres, and bilateral improvement had been noted in some patients. As reported in a study published in 2021 ( 26 ), cerebral reactivity and TIA frequency in the contralateral hemisphere can be improved following unilateral revascularization surgery in bilateral MMD. Figure 2 illustrates the imaging changes observed in patients with bilateral MMD after unilateral surgery in a typical case.…”

Section: Discussionmentioning

confidence: 59%

Postoperative cerebral infarction after revascularization in patients with moyamoya disease: Incidence and risk factors

Wang

Jiang²,

Tang³

et al. 2022

Front. Neurol.

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ObjectivesCerebral infarction is the major complication of revascularization surgery in patients with moyamoya disease (MMD), and we analyzed the possible causes of cerebral infarction after revascularization surgery for MMD.MethodsMMD patients who were admitted and underwent surgical revascularization at Shanghai Huashan Hospital from January 2019 to December 2021 were retrospectively analyzed.ResultsA total of 815 patients and 890 revascularization surgeries (677 first revascularization surgeries and 213 second revascularization surgeries) were included in this study; 453 (50.9%) were performed on the left side and 437 (49.1%) on the right side, with 779 (87.5%) combined procedures and 111 (12.5%) indirect bypasses included. The mean patient age at the time of these procedures was 44.6 ± 11.7 years (range 6–72 years). Postoperative cerebral infarctions were observed in 46 (5.17%) surgeries, among which 31 occurred after left hemisphere revascularization surgeries, with an incidence of 6.84%, and 15 occurred after right hemisphere revascularization surgeries, with an incidence of 3.43%. Of these, 30 (65.2%) occurred in the operated hemispheres, 2 (4.3%) in the contralateral hemisphere and 13 (28.3%) in the bilateral hemisphere. There were 11 cases of massive infarction (23.9%). The incidence of postoperative infarction in patients undergoing the first revascularization was 6% (41/677) and 2.3% (5/213) in the second revascularization surgeries. Initial presentation as infarction (P < 0.001), initial presentation as hemorrhage (P < 0.001), hypertension (P = 0.018), diabetes (P = 0.006), 1st or 2nd surgery and surgical side (P = 0.007) were found to be related to postoperative cerebral infarction. Initial presentation as infarction (OR = 2.934, 95% CI 1.453–5.928, P = 0.003), initial presentation as hemorrhage (OR = 0.149, 95% CI 0.035–0.641, P = 0.011), and 1st or 2nd surgery and surgical side (OR = 1.66, 95% CI 1.106–2.491, P = 0.014) were independently associated with cerebral infarction after revascularization surgeries.ConclusionsIn patients with MMD undergoing surgical revascularization, initial presentation as infarction and first revascularization surgery performed on the left hemisphere are independent risk factors for postoperative cerebral infarction, whereas initial presentation as hemorrhage is a protective factor.

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Contralateral improvement of cerebrovascular reactivity and TIA frequency after unilateral revascularization surgery in moyamoya vasculopathy

Cited by 12 publications

References 30 publications

Therapeutic Management of Ocular Ischemia in Takayasu’s Arteritis: A Case-Based Systematic Review

Therapeutic Management of Ocular Ischemia in Takayasu’s Arteritis: A Case-Based Systematic Review

Vascular smooth muscle cell dysfunction in neurodegeneration

Postoperative cerebral infarction after revascularization in patients with moyamoya disease: Incidence and risk factors

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