Longitudinal angiographic characterization of the efficacy of combined cerebral revascularization using minimally invasive encephalodurosynangiosis in patients with moyamoya angiopathy

Abstract

Moyamoya angiopathy (MMA) can be treated using direct, indirect, or combined revascularization procedures. We perform combined revascularization using the STA-MCA bypass and minimally invasive encephalodurosynangiosis (MIS-EDS). Due to lack of systematic analyses to date it remains unclear whether and to which extent this limited EDS serves as a growth source for extracerebral blood vessels into the brain. The objective of the current study is to characterize the extent of angiographic filling of MIS-EDS and STA-MCA bypass development over time and to determine possible predictors of EDS development in adult MMA patients. Single-center retrospective analysis of 81 MMA patients (139 hemispheres) treated with a MIS-EDS and STA-MCA bypass was performed. Angiographic images and clinical/operative data were reviewed and scored. Uni-/ and multivariate Cox regression analyses identified preoperative predictors of good EDS vascularization. At 3–6 months after surgery EDS showed moderate and high angiographic filling in 40% and 5% of hemispheres, respectively. After 12 months moderate and high filling was found in 57% and 4% of hemispheres, respectively. STA-MCA bypass filling was moderate in 47% and high in 7% of hemispheres at 3–6 months and 45% moderate and 9% high after 12 months. High STA-MCA bypass filling on angiography was a negative predictor of EDS development. MIS-EDS is a simple technique and serves as a source of vessel growth into the brain. EDS development lags behind that of STA-MCA bypass and can be recommended as an additive revascularization source when combined with a direct bypass.

Bibliometric and visual analysis of cerebral revascularization from 1999 to 2022

“…Peter Vajkoczy are also prominent researchers in the field of cerebral revascularization. Using STA-MCA bypass and minimally invasive cerebral sclerosis vascular anastomosis, he successfully reconstructed cerebral blood circulation in the treatment of moyamoya disease ( Lucia et al, 2022 ). He considered that the STA-MCA bypass was preferable to the MIS-EDS system.…”

The Development and Effect of Systemic Hypertension on Clinical and Radiological Outcome in Adult Moyamoya Angiopathy Following Revascularization Surgery: Experience of a Single European Institution

“…In particular, the grading of moyamoya vessel development was performed as previously described [ 17 ]. Bypass filling was determined as follows: grade 1 refers to the antegrade filing of one or two cortical MCA branches; grade 2 refers to ante- and retrograde filling of the MCA territory; grade 3 refers to filling of the entire MCA vascular territory [ 18 ].…”