Comparison of Long-Term Effect Between Direct and Indirect Bypass for Pediatric Ischemic-Type Moyamoya Disease: A Propensity Score-Matched Study

Zhao, Yahui; Lu, Junlin; Yu, Shaochen; Li, Jiaxi; Deng, Xiaofeng; Zhang, Yan; Zhang, Dong; Wang, Rong; Wang, Hao; Zhao, Yuanli

doi:10.3389/fneur.2019.00795

Cited by 18 publications

(11 citation statements)

References 27 publications

(35 reference statements)

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“…Liu et al, 2013;Matsushima et al, 1992Matsushima et al, , 1998Mesiwala et al, 2008;Zhai et al, 2018;M. Zhao et al, 2017;Y. Zhao et al, 2019Zheng et al, 2019).…”

Section: Search Resultsmentioning

confidence: 99%

A meta‐analysis of comparisons of various surgical treatments for moyamoya diseases

et al. 2021

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Purpose: Ischemia is one of the most familiar complications in the different procedures for moyamoya disease (MMD), but the optimal surgical approaches for MMD remain unknown. We aimed to evaluate the efficiency of various surgical treatments.Methods: A literature search word was performed through four databases such as Cochrane Library, Web of Science, PubMed, and EMBASE for the literature published until May 2021. The I 2 statistic was used to assess heterogeneity. A random/fixedeffects model was used to pool.Results: There are a total of 18 studies including three surgical treatments such as including indirect, direct, and combined bypass in this study. The result revealed that indirect bypass was related to a higher incidence of recurrence stroke compared to the direct and combined bypass treatment (p = .001). Furthermore, the cases undergoing direct bypass were associated with a better angiographic change than the indirect bypass (OR = 3.254, p = .013). Conclusion:This meta-analysis demonstrated a positive effect of using the direct and combined bypass to treat MMD compared to indirect bypass due to their lower rates of recurrence stroke. K E Y W O R D Scombined bypass, direct bypass, indirect bypass, moyamoya disease INTRODUCTIONMoyamoya disease (MMD) was first reported by Japanese literature in 1957 (Suzuki & Takaku, 1969), which was characterized by progressive stenosis and eventual occlusion of the major intracranial arteries in the proximity of the distal ends of internal carotid arteries (ICA). As a result of progressive blockage of the major vessels, networks of small collateral vessels develop and show a "puff of smoke" appearance on angiography, for which the name "moyamoya" (Japanese word for "puff of smoke") was coined (Suzuki & Takaku, 1969). MMD can cause strokes including two main phenotypes in populations: the This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2021 The Authors. Brain and Behavior published by Wiley Periodicals LLC ischemic and hemorrhagic types. Severe neuropsychological disorders, including cognitive decline, depression, and anxiety that cause the quality of life decline are also the main clinical feature of MMD (Cho et al., 2015). It is reported that MMD is common in East Asian people such as Korean and Japanese, as compared to Western Hemisphere people. According to a survey performed in Japan, the prevalence of MMD was approximately 3.16/100,000 (Wakai et al., 1997). The Japanese literature has reported that the prevalence of MMD had doubled from 3900 in 1994 to 7700 in 2003 (Kainth et al., 2013). The serious complications of MMD can lead to worse clinical outcomes and an increased mortality rate in MMD patients. Despite the Brain Behav.

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“…Liu et al, 2013;Matsushima et al, 1992Matsushima et al, , 1998Mesiwala et al, 2008;Zhai et al, 2018;M. Zhao et al, 2017;Y. Zhao et al, 2019Zheng et al, 2019).…”

Section: Search Resultsmentioning

confidence: 99%

A meta‐analysis of comparisons of various surgical treatments for moyamoya diseases

et al. 2021

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“…Many studies confirmed that DB and CB were more effective than indirect surgery in preventing recurrent stroke in adult (10, 30). However, for pediatric patients, indirect surgery can yield similar results with DB and CB (31), but there are few studies on superior surgical modality between DB and CB up until now. In our study, DB and CB had similar angiographic outcomes (postoperative collateral formation and bypass patency).…”

Section: Discussionmentioning

confidence: 99%

Angiographic Outcomes of Direct and Combined Bypass Surgery in Moyamoya Disease

Liu

et al. 2019

Front. Neurol.

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Objective: To identify associated risk factors for the angiographic outcomes after direct and combined bypass surgery in moyamoya disease (MMD).Methods: All direct and combined bypass procedures performed from June 2009 to May 2015 were screened in this prospective cohort study. Patients who acquired presurgical and follow-up catheter angiography were included. Bypass patency and postoperative collateral formation were evaluated. Univariate and multivariate logistic regression analyses were performed to determine the influence factors for bypass patency and postoperative collateral formation.Results: In total, 188 consecutive bypass procedures were included. After an 18-month median follow-up, the anastomosis patency rate was 88.3%. Postoperative collateral formation was associated with the patency of the anastomosis (Gamma = 0.891, p < 0.001). Multivariate logistic regression analysis showed that presence of hemorrhage (OR, 0.298; 95% CI, 0.125–0.709; p = 0.006) was associated with obstructed anastomosis. Among the 188 bypass surgeries, 125 (63.2%) hemispheres had good postoperative collateral formation and 85 (36.8%) had poor postoperative collateral formation. Multivariate logistic regression analysis showed that younger age at operation (OR, 2.396; 95% CI, 1.231–4.664; p = 0.010) was associated with good postoperative collateral formation, while the poor postoperative collateral formation was related to presence of hemorrhage (OR, 0.329; 95% CI, 0.143–0.758; p = 0.009) and dilated anterior choroidal artery (OR, 0.472; 95% CI, 0.240–0.929; p = 0.030).Conclusions: This study has demonstrated that presence of hemorrhage predicts lower patency rates. Younger age at operation was associated with good postoperative collateral formation, while the poor postoperative collateral formation was related to presence of hemorrhage and dilated anterior choroidal artery.

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“…For example, according to a meta-analysis, the estimated stroke rate was higher in indirect bypass (9.0%) than in direct bypass (4.5%) and combined bypass (6.0%) [ 14 ]. Our recent study showed that during the short term after surgery, direct bypass might be superior to indirect bypass in preventing recurrent ischemic strokes [ 15 ]. In addition, it usually takes months to improve cerebral blood flow after indirect bypass because neovascularization from connective tissue is not immediate [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative ischemic complications in pediatric moyamoya disease

Deng

Wang

et al. 2021

BMC Neurol

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Background Ischemic events are the most common postoperative complication in bypass surgery for moyamoya disease (MMD), but the risk factors for pediatric MMD remain unclear. The goal of the study was to investigate the risk factors for postoperative ischemic complications in pediatric MMD patients. Methods We retrospectively reviewed a consecutive series of pediatric MMD cases at Beijing Tiantan Hospital, Capital Medical University from June 2010 through June 2019. Preoperative clinical variables and radiographic findings were recorded, and logistic regression analysis was carried out to identify the risk factors for postoperative ischemic events. Results A total of 533 operations in 336 patients were included in this study. Postoperative complications occurred after 51 operations (9.6%), including 40/447 indirect bypass procedures, 9/70 direct bypass procedures, and 2/16 combined bypass procedures. Postoperative ischemic events were the most common complication and occurred in 30 patients after 31 procedures (8.9% per patient; 5.8% per operation), including 26/447 indirect bypass procedures, 4/70 direct bypass procedures, and 1/16 combined bypass procedures, and the incidence of these events did not differ significantly between indirect and non-indirect bypass (5.8% vs 5.8%; p = 0.999). Multivariate logistic regression analyses revealed that older age at operation (OR 1.129, 95% CI 1.011–1.260, p = 0.032) and posterior cerebral artery involvement (OR 2.587, 95% CI 1.030–6.496, p = 0.043) were significantly associated with postoperative ischemic events. Conclusion We speculate that older age at operation and posterior cerebral artery involvement are risk factors for postoperative ischemic events in pediatric MMD patients.

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Comparison of Long-Term Effect Between Direct and Indirect Bypass for Pediatric Ischemic-Type Moyamoya Disease: A Propensity Score-Matched Study

Cited by 18 publications

References 27 publications

A meta‐analysis of comparisons of various surgical treatments for moyamoya diseases

A meta‐analysis of comparisons of various surgical treatments for moyamoya diseases

Angiographic Outcomes of Direct and Combined Bypass Surgery in Moyamoya Disease

Risk factors for postoperative ischemic complications in pediatric moyamoya disease

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