Effects of aspirin and heparin treatment on perioperative outcomes in patients with Moyamoya disease

Kanamori, Fumiaki; Araki, Yoshio; Yokoyama, Kinya; Uda, Kenji; Mamiya, Takashi; Nishihori, Masahiro; Izumi, Tohru; Okamoto, Sho; Natsume, Atsushi

doi:10.1007/s00701-020-04668-0

Cited by 22 publications

(26 citation statements)

References 14 publications

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“…We found a significant difference in the postsurgical incidence of ischemic and hemorrhagic stroke among the group in which aspirin was continued, the group in which it was discontinued only on the day of surgery, the group in which it was discontinued 3 days before surgery, and the group in which it was not used. 25 The case in the present report belonged to the group in which aspirin administration was discontinued 3 days before surgery. However, the study found that the appearance of white thrombi during the bypass procedure was significantly reduced in the aspirin-treated group.…”

Section: Discussionmentioning

confidence: 79%

“…24 There have also been a few reports testing the outcomes of perioperative aspirin administration. [25][26][27] Rashad et al 26 reported that strict blood pressure control and aspirin administration can reduce the potential risk of surgical complications in combined revascularization for pediatric patients with MMD. On the one hand, their use of aspirin was in close agreement with the regimen used in our case, with administration stopping 3 days before surgery and starting the day after surgery.…”

Section: Observationsmentioning

confidence: 99%

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Spatially separate cerebral infarction in the posterior cerebral artery territory after combined revascularization of the middle cerebral artery territory in an adult patient with moyamoya disease and fetal-type posterior communicating artery: illustrative case

Araki

Yokoyama

Uda

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Remote cerebral infarction after combined revascularization of the middle cerebral artery (MCA) territory is rare in patients with moyamoya disease (MMD) with a fetal-type posterior communicating artery (PCoA). OBSERVATIONS A 57-year-old woman developed numbness in her right upper limb and transient motor weakness and was diagnosed with MMD. She also had a headache attack and a scintillating scotoma in the right visual field. Preoperative magnetic resonance angiography (MRA) showed stenosis of the left posterior cerebral artery (PCA). Combined revascularization was performed for the left MCA territory. No new neurological deficits were observed for 2 days after the operation, but right hemianopia, alexia, and agraphia appeared on postoperative day (POD) 4. Magnetic resonance imaging showed a new left occipitoparietal lobe infarction, and MRA showed occlusion of the distal left PCA. After that point, the alexia and agraphia gradually improved, but right hemianopia remained at the time of discharge on POD 18. LESSONS Cerebral ischemia in the PCA territory may occur after combined revascularization of the MCA territory in patients with fetal-type PCoA. For these cases, a double-barrel bypass or indirect revascularization to induce a slow conversion could be considered on its own as a treatment option.

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Section: Discussionmentioning

confidence: 79%

Section: Observationsmentioning

confidence: 99%

Spatially separate cerebral infarction in the posterior cerebral artery territory after combined revascularization of the middle cerebral artery territory in an adult patient with moyamoya disease and fetal-type posterior communicating artery: illustrative case

Araki

Yokoyama

Uda

et al. 2022

Journal of Neurosurgery: Case Lessons

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“…Intraoperative heparin did not affect the surgical or medical complication rates in this study. Kanamori et al 39 reported an increased risk of perioperative hemorrhagic complications in patients with moyamoya disease receiving heparin treatment compared with those who did not receive heparin. This study did not find an association between heparin and complication rates.…”

Section: Discussionmentioning

confidence: 99%

Modern Appraisal of Patency and Complications in Cerebral Bypass Surgery: A Single Institution Experience

Farooq

Heller

Noureldine

et al. 2022

Operative Neurosurgery

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BACKGROUND: Cerebral bypass is a valuable surgical technique in well-selected patient populations. Updated clinical guidelines and improved surgical techniques warrant a contemporary reevaluation of the complications and patency to inform clinical practice and enhance postoperative patient care. OBJECTIVE: To assess the complication rates and postoperative graft patency for the 3 most common indications for bypass surgery: moyamoya disease, intracranial atherosclerosis, and intracranial aneurysms. METHODS: Perioperative notes of 175 consecutive bypass patients at a single institution were retrospectively identified to evaluate the clinical course and complications of surgery. RESULTS: The rate of total postoperative complications between moyamoya disease (9 of 98, 9.2%), intracranial atherosclerotic disease (7 of 57, 12.3%), and intracranial aneurysm (4 of 20, 20%) was not statistically different (P = .33). Immediate postoperative bypass patency was significantly higher in moyamoya disease (90 of 96, 93.8%) and intracranial atherosclerotic disease (48 of 51, 94.1%) than in intracranial aneurysm (13 of 18, 72.2%; P = .02). Intravenous heparin administration during bypass suturing was negatively associated with immediate postoperative patency (87% heparin patency vs 99% no heparin patency; P = .02). Double-barrel bypass trended toward an increased risk of wound healing complications (2 of 13, 15.4%) compared with the single-barrel bypass technique (4 of 156, 2.6%; P = .07). CONCLUSION: Cerebral bypass surgery remains an excellent surgical treatment for moyamoya disease, intracranial atherosclerosis, and intracranial aneurysms. This study suggests bypass is safer in moyamoya disease and intracranial atherosclerosis. Additional studies to clarify the risk of single-barrel vs double-barrel bypass and intraoperative heparin-stratified complications may be beneficial.

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“…As discussed in a previous study, some reports of the appearance of white thrombi during surgery for STA-MCA bypass have already been reported. [14,22,33] When analyzed for the appearance of white thrombi during the operation, Mikami et al [22] stated that higher MRA scores were significantly associated with thrombogenesis. [18] As part of a discussion based on this finding, it is a remarkable anatomical structure indicating that the recipient artery on the brain surface is fragile and thin in patients with advanced MMD presenting with higher MRA scores.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The preoperative focal cerebral blood flow status may be associated with slow flow in the bypass graft after combined surgery for moyamoya disease

Araki

Yokoyama

Uda

et al. 2022

Surgical Neurology International

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Background: The aim of this study was to investigate the association between early postoperative slow flow in bypass grafts and preoperative focal cerebral blood flow (CBF) in patients who underwent combined surgery for moyamoya disease (MMD). Methods: The subjects were 18 patients (22 surgeries) who underwent single photon emission computed tomography (SPECT) before surgery. The CBF value of the middle cerebral artery territory was extracted from the SPECT data, and the value relative to the ipsilateral cerebellar CBF (relative CBF, or RCBF) was calculated. The association between RCBF and early postoperative slow flow in the bypass graft was investigated. In addition, the correlation between the revascularization effect and preoperative RCBF was analyzed. Results: In four of 22 surgeries (18.2%), slow flow in the bypass graft was identified in the early postoperative period. Preoperative RCBF in the slow flow and patent groups was 0.86 ± 0.15 and 0.87 ± 0.15, respectively, with no significant difference (P = 0.72). The signal intensity of four slow-flowed bypasses was improved in all cases on magnetic resonance angiography images captured during the chronic phase (mean of 3.3 months postoperatively). The revascularization scores were 2 ± 0.82 and 2.1 ± 0.68 in the slow flow and patent groups, respectively, and did not differ significantly (P = 0.78). A significant correlation was not observed between preoperative RCBF and the revascularization effect. Conclusion: No significant association was observed between preoperative RCBF and early postoperative slow flow in bypass grafts in patients with MMD undergoing combined surgery. Given the high rate of improved depiction of slow-flowed bypass in the chronic postoperative phase, the conceptual significance of an opportune surgical intervention is to maintain CBF by supporting the patient’s own intracranial-extracranial conversion function.

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Effects of aspirin and heparin treatment on perioperative outcomes in patients with Moyamoya disease

Cited by 22 publications

References 14 publications

Spatially separate cerebral infarction in the posterior cerebral artery territory after combined revascularization of the middle cerebral artery territory in an adult patient with moyamoya disease and fetal-type posterior communicating artery: illustrative case

Spatially separate cerebral infarction in the posterior cerebral artery territory after combined revascularization of the middle cerebral artery territory in an adult patient with moyamoya disease and fetal-type posterior communicating artery: illustrative case

Modern Appraisal of Patency and Complications in Cerebral Bypass Surgery: A Single Institution Experience

The preoperative focal cerebral blood flow status may be associated with slow flow in the bypass graft after combined surgery for moyamoya disease

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