Rapid Resolution of Brain Ischemic Hypoxia After Cerebral Revascularization in Moyamoya Disease

Arikán, Fuat; Vilalta, J; Torné, Ramón; Noguer, M.; Lorenzo-Bosquet, Carles; Sahuquillo, Juan

doi:10.1227/neu.0000000000000609

Cited by 17 publications

(10 citation statements)

References 76 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is possible that based on these findings, PbtO2/PaO2 and PbtO2/FiO2 ratio may be a better indicator to severity of brain injury than absolute PbtO2. The limitations of standalone PbtO2 monitoring was recognized by Arikan et al (35) who were able to calculate a hypoxic threshold using a ratio of PbtO2/PaO2 suggesting that in the absence of hypoxemia (low PaO2) and at a constant cerebral metabolic rate of oxygen (CMRO2), ratios <0.10 indicated covert hypoxia and a deficient delivery of oxygen into the brain.…”

Section: Discussionmentioning

confidence: 99%

Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury

et al. 2020

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury

et al. 2020

View full text Add to dashboard Cite

show abstract

“…1 However, they carry the risk of postoperative hyperperfusion that could lead to neurological deficits. [2][3][4] We reported previously that hyperperfusion-related transient neurological deficits (TNDs) occurred in 31.5% of adult patients who underwent direct bypass procedures.…”

mentioning

confidence: 99%

Edaravone Reduces Hyperperfusion-Related Neurological Deficits in Adult Moyamoya Disease

Uchino

Nakayama

Kazumata

et al. 2016

Stroke

View full text Add to dashboard Cite

Background and Purpose-Postoperative hyperperfusion-related transient neurological deficits (TNDs) are frequently observed in adult patients with moyamoya disease who undergo direct bypass procedures. The present study evaluated the effect of the free radical scavenger edaravone on postoperative hyperperfusion in adult moyamoya disease. Methods-This study included 92 hemispheres in 72 adult patients who underwent direct bypass for moyamoya disease.Serial measurements of cerebral blood flow were conducted immediately after surgery and on postoperative days 2 and 7. In 40 hemispheres for 36 patients, edaravone (60 mg/d) was administered from the day of surgery to postsurgical day 7. The incidence of postoperative hyperperfusion and associated TNDs were compared with a control group that included 52 hemispheres in 36 patients. Results-Radiological hyperperfusion was observed in 28 of 40 (70.0%) and 39 of 52 (75.0%) hemispheres in the edaravone and control groups, respectively (P=0.30). Hyperperfusion-related TND incidences were significantly lower in the edaravone group compared with the control group (12.5% versus 32.7%; P=0.024). Multivariate analysis demonstrated that edaravone administration (P=0.009) and left-sided surgery (P=0.037) were significantly correlated with hyperperfusionrelated TNDs (odds ratios, 0.3 and 4.2, respectively). Conclusions-Perioperative administration of edaravone reduced the incidence of hyperperfusion-related TNDs after direct bypass procedures in adult patients with moyamoya disease.

show abstract

“…Previous studies reported that STA-MCA bypass increases STA and MCA blood flow during the early vascular remodeling period (14,15). The increase of STA blood flow may be associated with the low resistance of the intracranial vascular bed, while the increase of MCA blood flow may be due to the support of the STA.…”

Section: Discussionmentioning

confidence: 94%

“…Intracranial and extracranial vascular reconstruction surgery mainly includes direct and indirect revascularization. Direct revascularization increases the cerebral blood flow and instantly improves cerebral metabolism (14,15), but the drawback is that STA or MCA branches of moyamoya patients may be fragile and easily occluded; thus, the long-term effect of direct revascularization remains elusive. In addition, patients with direct revascularization are prone to developing cerebral hemodynamic disturbances and perioperative complications (16).…”

Section: Discussionmentioning

confidence: 99%

Clinical and angiographic outcomes after combined direct and indirect bypass in adult patients with moyamoya disease: A retrospective study of 76 procedures

et al. 2018

View full text Add to dashboard Cite

Abstract. The present retrospective study was performed to evaluate the clinical outcome, as well as post-operative collateral formation and revascularization patterns in combined bypass. Surgical revascularization has been the mainstay of treatment for moyamoya patients. A total of 76 hemispheres from 64 moyamoya patients undergoing combined superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and encephalo-duro-myo-synangiosis (EDMS) were retrospectively reviewed. Computed tomography perfusion and DSA were routinely performed. Modified Rankin scale (mRS) scoring and Kaplan-Meier analysis were performed, and post-operative collateral grading on digital subtraction angiography (DSA), reconstruction patterns and vessel diameter were measured to evaluate the revascularization area and vascular compensatory effect. During the follow-up period, the chief complaint was partially alleviated in 57/64 patients (89.1%). In all patients, mRS was significantly decreased after the operation. Good revascularization was established in most patients at 6 months after the surgery: 92.1% of sides were scored as 2 and 77.6% were scored as 3 by post-operative collateral grading on DSA. Dominant collateral revascularization originating from EDMS was more frequent than that from STA-MCA anastomosis (31 vs. 19 hemispheres) at 6-month follow-up. Morphologically, the calibers of the STA main trunk (2.60±0.65 mm) increased profoundly at the first 10 post-operative days (3.32±1.05 mm) and shrank back to pre-operative status at 6 months (2.20±1.01 mm) and 12 months (2.36±0.73 mm) according to DSA examination. Middle meningeal artery (MMA) and deep temporal artery (DTA) demonstrated continuous augmentation during the follow-up time (from 1.30±0.46 to 1.87±0.69 mm for MMA and 1.11±0.25 to 2.11±1.16 mm for DTA). These results strongly suggested that combined STA-MCA bypass and EDMS provided efficient revascularization and reduced acute cerebral events. The direct STA-MCA bypass provided early augmentation of cerebral perfusion, whereas the indirect EDMS provided a more durable long-term revascularization, indicating a complementary association between the two revascularization methods.

show abstract

Rapid Resolution of Brain Ischemic Hypoxia After Cerebral Revascularization in Moyamoya Disease

Abstract: Direct anastomosis quickly improves cerebral oxygenation, immediately reducing the risk of ischemic stroke in both pediatric and adult patients. Intraoperative PtiO2 monitoring is a very reliable tool to verify the effectiveness of this revascularization procedure.

Cited by 17 publications

References 76 publications

Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury

Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury

Edaravone Reduces Hyperperfusion-Related Neurological Deficits in Adult Moyamoya Disease

Clinical and angiographic outcomes after combined direct and indirect bypass in adult patients with moyamoya disease: A retrospective study of 76 procedures

Contact Info

Product

Resources

About