Long-term outcome of superficial temporal artery–middle cerebral artery bypass for patients with moyamoya disease in the US

Mesiwala, Ali H.; Sviri, Gill E.; Fatemi, Nasrin; Britz, Gavin W.; Newell, David W.

doi:10.3171/foc/2008/24/2/e15

Cited by 127 publications

(82 citation statements)

References 24 publications

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“…However, because revascularization using the indirect procedure often results in insufficient revascularization in adults, the direct/combined procedure has been increasingly used. 1,2,6,9,14,15,26,39,44 A limitation of this study was its retrospective nature. Because our surgical procedure also includes several steps of the indirect procedure (inverting dura matter, suturing temporalis muscle to the dura, and the placement of the pericranial flap), the result cannot be simply interpreted as a direct comparison between the direct STA-MCA bypass and indirect procedure alone.…”

Section: Discussionmentioning

confidence: 99%

The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review

Kazumata

Ito

Tokairin

et al. 2014

JNS

156

111

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M oyaMoya disease (MMD) is a progressive stenoocclusive cerebrovascular disease characterized by collateral vascular networks that look like "a puff of smoke" (moyamoya vessels) at the base of the brain. 35,58 Various revascularization procedures have been shown to improve cerebral hemodynamics and decrease the risk of ischemic attack; however, hemodynamic compromises and bleeding-prone vasculopathy lead to postoperative neurological morbidity. In anesthesia management, hypocapnia during surgery induces critical decreases in cerebral blood flow. It is also well known that crying induces hyperventilation and stroke during the perioperative period in children. 45,51 Hemodynamic compromise is also aggravated by blood loss, decreased circulating volume, and low blood pressure. 38,53 Furthermore, recent studies have shown that postoperative hyperperfusion develops frequently after surgery. 11,60 A previous review suggested that direct and combined bypass for MMD provide better collateral circula- Object. Although combined direct and indirect anastomosis in patients with moyamoya disease immediately increases cerebral blood flow, the surgical procedure is more complex. Data pertinent to the postoperative complications associated with combined bypass are relatively scarce compared with those associated with indirect bypass. This study investigated the incidence and characteristics of postoperative stroke in combined bypass and compared them with those determined from a literature review to obtain data from a large population.Methods. A total of 358 revascularization procedures in 236 patients were retrospectively assessed by reviewing clinical charts and radiological data. PubMed was searched for published studies on surgical treatment to determine the incidence of postoperative complications in a larger population.Results. Seventeen instances of postoperative stroke were observed in 16 patients (4.7% per surgery, 95% CI 2.8%-7.5%). Postoperative stroke was more frequent (7.9% per surgery) in adults than in pediatric patients (1.7% per surgery, OR 4.07, 95% CI 1.12-14.7; p < 0.05). Acute progression of stenoocclusive changes were identified in the major cerebral arteries (anterior cerebral artery, n = 3; middle cerebral artery, n = 1; posterior cerebral artery, n = 2). The postoperative stroke rate was comparable with that (5.4%) determined from a literature search that included studies reporting more than 2000 direct/combined procedures. No differences in the stroke rates between the direct/combined and indirect procedures were found. In the literature review, direct/combined bypass was more often associated with excellent revascularization (angiographic opacification greater than two-thirds) than indirect bypass (p < 0.05).Conclusions. This experience of 358 consecutive procedures is one of the largest series for which the postoperative stoke rate for direct/combined bypass performed with a unified strategy has been reported. A systematic review confirmed that the postoperative stroke rate for the direct/combined pro...

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Section: Discussionmentioning

confidence: 99%

The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review

Kazumata

Ito

Tokairin

et al. 2014

JNS

156

111

View full text Add to dashboard Cite

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“…Many series have reported the efficacy of revascularization in this syndrome by using primarily direct superficial temporal artery (STA)-MCA bypass. [82][83][84][85][86][87][88][89] PET studies in Moyamoya disease have demonstrated re- duced CBF and CO 2 response and increased CBV, MTT, and OEF. 90 CBF is significantly lower in patients with Moyamoya disease than in healthy subjects of the same age.…”

Section: Moyamoya Diseasementioning

confidence: 99%

The Acetazolamide Challenge: Techniques and Applications in the Evaluation of Chronic Cerebral Ischemia

Vagal¹,

Leach²,

Fernández-Ulloa³

et al. 2009

AJNR Am J Neuroradiol

160

116

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SUMMARY:The acetazolamide (ACZ) challenge test is a useful clinical tool and a reliable predictor of critically reduced perfusion. In patients with chronic steno-occlusive disease, the ability to maintain normal cerebral blood flow by reducing vascular resistance secondary to autoregulatory vasodilation is compromised. Identification of the presence and degree of autoregulatory vasodilation (reflecting the cerebrovascular reserve) is a significant prognostic factor in patients with chronic cerebrovascular disease. The pharmacologic challenge of a vasodilatory stimulus such as ACZ can also be used to optimize the treatment strategies for these patients. The pathophysiology, methods, and clinical applications of the ACZ challenge test are discussed in this article. Viability of the cerebral parenchyma is dependent on the ability of the brain vasculature to provide adequate levels of cerebral blood flow (CBF). In patients with chronic stenoocclusive disease, the ability to maintain normal CBF by reducing vascular resistance is compromised. Identification of the degree of autoregulatory vasodilation reflects cerebrovascular reserve (CVR), which is a significant prognostic factor in chronic cerebrovascular disease.1-5 Flow reserve can be assessed with the use of paired blood flow measurements, with the initial measurement obtained at baseline and the second, after a vasodilatory stimulus, such as acetazolamide (ACZ). 6 Pathophysiology of Chronic Cerebrovascular DiseaseChronic cerebral hypoperfusion is usually the result of occlusion or stenosis of large arteries in the neck or the circle of Willis. Clinical symptoms and manifestations of brain ischemia in patients with chronic cerebrovascular disease (CVD) develop as a consequence of 2 main mechanisms: embolic events from atherosclerotic plaques resulting in local compromise of blood flow and systemic hemodynamic alterations that further reduce an already compromised cerebral perfusion state. 7The hemodynamic changes due to a decline in cerebral perfusion pressure have been studied by many investigators. 6,[8][9][10][11] Chronic CBF restriction causes a progressive decrease in cerebral perfusion pressure (CPP). Initially, decreases of CPP cause varying degrees of autoregulatory vasodilation of small distal arterioles.12 Powers 10 and Powers et al 11 proposed a 2-stage classification of hemodynamic impairment in patients with CVD. In stage I (autoregulatory vasodilation), autoregulation reduces cerebral vascular resistance. CBF and oxygen extraction fraction (OEF) are not significantly changed. Increases of cerebral blood volume (CBV) and mean transit time (MTT) are 2 parameters that reflect this initial phase of compensatory autoregulatory vasodilation. Further decreases of CPP beyond cerebral autoregulatory vasodilation capacity eventually result in stage II (autoregulatory failure), characterized by decreases of CBF and increases of OEF. When the CBF decreases, neurons increase the fraction of oxygen extracted from the blood to maintain normal neurologic function. ...

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“…1,2 In patients with Moyamoya disease, a progressive narrowing of the supraclinoid internal carotid artery (ICA) and its proximal branches, negative or severely reduced CVR has been used to identify patients who may benefit from surgical revascularization. 3,4 However, the impact of steal phenomenon on normal-appearing brain tissue (ie, in the absence of overt infarction) has not been previously investigated.…”

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confidence: 99%

Impaired Cerebrovascular Reactivity With Steal Phenomenon Is Associated With Increased Diffusion in White Matter of Patients With Moyamoya Disease

Conklin

Fierstra

Crawley

et al. 2010

Stroke

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Background and Purpose-Reduced cerebrovascular reactivity (CVR) with steal phenomenon is an independent predictor for stroke and may indicate tissue exposed to episodic low-grade ischemia. The apparent diffusion coefficient (ADC) calculated using diffusion-weighted MRI is effective in characterizing focal brain ischemia and subtle structural changes in normal-appearing white matter (WM). We hypothesized that regions of steal phenomenon are associated with increased ADC in normal-appearing WM of patients with Moyamoya disease. Methods-Twenty-two patients with unilateral CVR impairment secondary to Moyamoya disease and 12 healthy control subjects underwent diffusion-weighted MRI and functional MRI mapping of the cerebrovascular response to hypercapnia. Parametric maps of ADC and CVR were calculated, coregistered, and segmented using automated image processing methods. ADC of normal-appearing WM was compared between hemispheres, and between WM with negative CVR (ie, steal phenomenon) and WM with positive CVR. Results-In patients, ADC of normal-appearing WM was elevated in the hemisphere ipsilateral to the CVR impairment compared with the contralateral hemisphere (PϽ0.005) and in WM with negative CVR compared with WM with positive CVR (PϽ0.001). WM in regions of steal phenomenon within the affected hemisphere had higher ADC than homologous contralateral WM (PϽ0.005). In control subjects, negative CVR in WM was not associated with elevated ADC. Conclusions-Regions

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Long-term outcome of superficial temporal artery–middle cerebral artery bypass for patients with moyamoya disease in the US

Cited by 127 publications

References 24 publications

The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review

The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review

The Acetazolamide Challenge: Techniques and Applications in the Evaluation of Chronic Cerebral Ischemia

Impaired Cerebrovascular Reactivity With Steal Phenomenon Is Associated With Increased Diffusion in White Matter of Patients With Moyamoya Disease

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