Analysis of Rescue Strategies for Acute Thrombosis in Moyamoya Patients during STA-MCA Bypass Surgery and the Literature Review

Abstract

Background and objectives: Moyamoya disease is most improtantly treated with superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery, and the intraoperative patency of the reconstructive vessels is critical to the efficacy of the procedure. This study aimed to evaluate the efficacy of intra-arterially infused tirofiban for the treatment of acute thrombosis during STA-MCA bypass surgery and countermeasures for acute thrombosis. Methods: We retrospectively reviewed the clinical and imaging data, surgical procedure, and follow-up outcomes of eight patients who developed acute thrombosis during the surgical procedure. We implemented the different thrombolytic methods to evaluate the optimal thrombosis management during the bypass surgery. After three months, we assessed neurological functions using the modified Rankin Scale (mRS) and conducted a literature review using PubMed. Results: Eight patients (four male patients and four female patients) developed acute thrombosis during the bypass surgery. Of the eight patients, two underwent re-anastomosis after thrombus removal, three received local injections of tirofiban into the anastomosis or the branches of the superficial temporal artery, and three underwent superselective intra-arterial tirofiban infusion using a microcatheter. Thrombosis were resolved, and arteries were recanalized in all patients. The mRS score was 0 in all patients. No major ischemic or hemorrhagic complications occurred. Conclusion: Our treatment methods were efficacious in the management of acute thrombosis. Intra-arterial tirofiban administration seems to be a simple and effective treatment option for acute thrombosis during STA-MCA bypass surgery.