Follow-up outcomes of different bypass surgical modalities for adults with ischaemic-type moyamoya disease

Gao, Peng; Chen, Di; Yuan, Shanpeng; Kong, Tengxiao; Zhang, Dongtao; Zhu, Xiao‐Yong; Li, Xueyuan; Zhen, Yingwei; Yan, Dongming

doi:10.1080/02688697.2021.1981239

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…This is most likely because an unfavourable, peri- or postoperative course leading to disability is fortunately a very rare event. Gao et al 141 had also studied the disability for their 371 patients. Accordingly, out of the 281 patients undergoing combined revascularization only 1% and out of the 90 patients undergoing indirect revascularization only 2% had a disabling outcome.…”

Section: Resultsmentioning

confidence: 99%

“…Our analysis identified no RCT and 7 observational study on adults with MMA, comparing combined with indirect revascularization strategies for the outcomes selected in these guidelines. Of seven studies, five studies 125,[139][140][141][142] reported any stroke and three studies 125,143,144 assessed disability as outcome parameter.…”

Section: Adult Patientsmentioning

confidence: 99%

“…The stroke incidence for the combined revascularization group was 12%, while 22% suffered stroke following indirect bypass alone (RR 0.53 [95% CI: 0.11-2.53]). The largest study was published recently by Gao et al 141 Here, 281 patients underwent combined/ direct revascularization strategies and 90 patients received an indirect bypass. Only adult patients were reported with a mean age of 39.0 ± 11.1 years.…”

Section: Adult Patientsmentioning

confidence: 99%

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European Stroke Organisation (ESO) Guidelines on Moyamoya angiopathy Endorsed by Vascular European Reference Network (VASCERN)

Bersano

Khan²,

Gimeno

et al. 2023

European Stroke Journal

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The European Stroke Organisation (ESO) guidelines on Moyamoya Angiopathy (MMA), developed according to ESO standard operating procedure and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, were compiled to assist clinicians in managing patients with MMA in their decision making. A working group involving neurologists, neurosurgeons, a geneticist and methodologists identified nine relevant clinical questions, performed systematic literature reviews and, whenever possible, meta-analyses. Quality assessment of the available evidence was made with specific recommendations. In the absence of sufficient evidence to provide recommendations, Expert Consensus Statements were formulated. Based on low quality evidence from one RCT, we recommend direct bypass surgery in adult patients with haemorrhagic presentation. For ischaemic adult patients and children, we suggest revascularization surgery using direct or combined technique rather than indirect, in the presence of haemodynamic impairment and with an interval of 6–12 weeks between the last cerebrovascular event and surgery. In the absence of robust trial, an Expert Consensus was reached recommending long-term antiplatelet therapy in non-haemorrhagic MMA, as it may reduce risk of embolic stroke. We also agreed on the utility of performing pre- and post- operative haemodynamic and posterior cerebral artery assessment. There were insufficient data to recommend systematic variant screening of RNF213 p.R4810K. Additionally, we suggest that long-term MMA neuroimaging follow up may guide therapeutic decision making by assessing the disease progression. We believe that this guideline, which is the first comprehensive European guideline on MMA management using GRADE methods will assist clinicians to choose the most effective management strategy for MMA.

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Section: Resultsmentioning

confidence: 99%

Section: Adult Patientsmentioning

confidence: 99%

Section: Adult Patientsmentioning

confidence: 99%

See 1 more Smart Citation

European Stroke Organisation (ESO) Guidelines on Moyamoya angiopathy Endorsed by Vascular European Reference Network (VASCERN)

Bersano

Khan²,

Gimeno

et al. 2023

European Stroke Journal

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Risk Factors for Ischemic Stroke After Revascularization Surgery in Patients with Moyamoya Disease: An Age-Stratified Comparative Meta-Analysis

et al. 2023

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Outcomes after superficial temporal artery–middle cerebral artery anastomosis combined with multiple burr hole surgery and dural inversion synangiosis for moyamoya disease in adults

Zheng

et al. 2022

Front. Surg.

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ObjectiveSeveral forms of cerebral revascularization have been carried out to treat moyamoya disease, however, the existing methods are accompanied by a variety of complications. In this study, the authors aimed to evaluate the clinical and angiographic outcomes of a new surgical procedure: superficial temporal artery–middle cerebral artery (STA-MCA) anastomosis combined with multiple burr hole (MBH) surgery and dural inversion synangiosis for the treatment of moyamoya disease in adults.MethodsPatients treated for moyamoya disease from August 2019 to July 2021 were retrospectively reviewed. Clinical data, including perioperative complications and follow-up outcomes, were noted. Preoperative and postoperative angiograms were compared, and the diameters of the frontal branch of the superficial temporal artery (F-STA), the deep temporal artery (DTA), the distal superficial temporal artery (STA) before the bifurcation and the middle meningeal artery (MMA) were measured on preoperative and postoperative angiograms. Meanwhile, a Matsushima score was assigned from postoperative angiograms.ResultsThis study included 66 patients (67 hemispheres). During the follow-up period, a median of 18 (IQR, 13–21) months, no stroke or death occurred in any of the patients. The clinical outcomes were excellent in 27 patients (40.9%), good in 34 patients (51.6%), fair in 4 patients (6.0%), and poor in 1 patient (1.5%); the overall rate of favorable clinical outcomes (excellent and good) was 92.5%. The modified Rankin Scale (mRS) score was significantly improved at follow-up (P < 0.001). There were 41 hemispheres imaged by cerebral angiography after the operation, at a median postoperative interval of 9 (IQR, 8–12) months; among them, 34 (82.9%) hemispheres had Matsushima scores of grade A and grade B. The average postoperative diameters in the STA, DTA and MMA were increased significantly in 41 hemispheres at follow-up (P < 0.001). Sixteen (24.2%) patients suffered from perioperative complications, including focal hyperperfusion syndrome (HS) in 8 (12.2%) patients, cerebral infarction in 3 (4.5%) patients (including one case accompanied by wound infection), cerebral hemorrhage in 2 (3.0%) patients, seizures in 2 (3.0%) patients, and subdural effusion in 1 (1.5%) patient.ConclusionsThe procedure of STA-MCA anastomosis combined with MBH surgery and dural inversion synangiosis may be a safe and effective treatment for adult patients with moyamoya disease.

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Follow-up outcomes of different bypass surgical modalities for adults with ischaemic-type moyamoya disease

Cited by 3 publications

References 31 publications

European Stroke Organisation (ESO) Guidelines on Moyamoya angiopathy Endorsed by Vascular European Reference Network (VASCERN)

European Stroke Organisation (ESO) Guidelines on Moyamoya angiopathy Endorsed by Vascular European Reference Network (VASCERN)

Risk Factors for Ischemic Stroke After Revascularization Surgery in Patients with Moyamoya Disease: An Age-Stratified Comparative Meta-Analysis

Outcomes after superficial temporal artery–middle cerebral artery anastomosis combined with multiple burr hole surgery and dural inversion synangiosis for moyamoya disease in adults

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