Predictive factors for acute thrombogenesis occurring immediately after bypass procedure for moyamoya disease

Mikami, Takeshi; Suzuki, Hime; Ukai, Ryo; Komatsu, Katsuya; Akiyama, Yukinori; Wanibuchi, Masahiko; Houkin, Kiyohiro; Mikuni, Nobuhiro

doi:10.1007/s10143-019-01086-4

Cited by 19 publications

(11 citation statements)

References 33 publications

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“… 5 , 8 While EC-IC bypass facilitates the instantaneous restoration of blood flow and opportunity for direct vessel network augmentation, postoperative monitoring of bypass patency is imperative to detect potential anastomosis complications. 9 , 10 , 11 , 12 Conventional imaging modalities used include magnetic resonance angiography, computed tomography angiography (CTA), and catheter-based digital subtraction angiography; however, these techniques are time consuming, cannot be performed at the bedside, demand significant institutional resources, and expose the patient to additional risk in the form of radiation, contrast administration, and/or intravascular catheterization. For these reasons, alternative modalities are desired to optimize the safety, efficacy, and frequency of postoperative bypass imaging.…”

Section: Introductionmentioning

confidence: 99%

Safety, Feasibility, and Patient-Rated Outcome of Sonolucent Cranioplasty in Extracranial-Intracranial Bypass Surgery to Allow for Transcranioplasty Ultrasound Assessment

et al. 2020

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Objective We sought to analyze the safety and feasibility of elective sonolucent cranioplasty in the setting of extracranial-to-intracranial (EC-IC) bypass surgery to monitor bypass patency using ultrasound. Methods Patients who underwent direct EC-IC bypass surgery agreed to sonolucent cranioplasty at the time of surgery and received a sonolucent polymethyl methacrylate (PMMA) implant. Besides monitoring clinical outcome, all patients received transcranioplasty ultrasound (TCUS) on postoperative day 1 and at last follow-up. In addition, bypass patency was confirmed using catheter angiogram and fit of implant using computed tomography. Patient-rated outcome was assessed through phone questionnaire. Results EC-IC bypass surgery with PMMA cranioplasty was successful in all 7 patients with patent bypasses on postoperative angiogram. Direct TCUS was feasible in all patients, and bypass patency was monitored. There were no complications such as postoperative hemorrhagic/ischemic complications related to the bypass procedure in this patient population, as well as no complications related to the PMMA implant. Postoperative computed tomography showed favorable cosmetic results of the PMMA implant in both the pterional area for superficial temporal artery−middle cerebral artery bypasses and parietooccipital area for occipital artery−middle cerebral artery bypasses as confirmed by high-rated overall patient satisfaction with favorable cosmetic, pain, and sensory patient-rated outcomes. Conclusions In this study we were able to show that this novel technique is safe, allows for patency assessment of the EC-IC bypass using bedside TCUS technique, and is cosmetically satisfying for patients.

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Section: Introductionmentioning

confidence: 99%

Safety, Feasibility, and Patient-Rated Outcome of Sonolucent Cranioplasty in Extracranial-Intracranial Bypass Surgery to Allow for Transcranioplasty Ultrasound Assessment

et al. 2020

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“…[ 2 ] were significantly higher in patients with acute thrombogenesis than those in counterparts. [ 5 ] With regard to the prediction of thrombogenesis, we can see that this case was a case in which the MRA score by Houkin et al . was 9 points, and it was easy to form a clot.…”

Section: Discussionmentioning

confidence: 91%

“…This case is also a progressive moyamoya disease and the recipient vessel’s walls were thin and fragile, so damage to the intima was suspected to facilitate the formation of a white thrombus as reported by Mikami et al . [ 5 ] Because the recipient vessels are thin and fragile in advanced moyamoya disease, we considered that special attention must be taken to protect the intima during the procedure.…”

Section: Discussionmentioning

confidence: 99%

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Delayed reopening of a superficial temporal artery to middle cerebral artery bypass graft occluded by a white thrombus during surgery

Takahashi

Yoshida

2020

Surgical Neurology International

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Background: To the authors’ knowledge, reopening of a superficial temporal artery to middle cerebral artery (STA-MCA) bypass graft occluded by a white thrombus during the procedure and was observed several months after the surgery is relatively rare. Case Description: The authors encountered a case of moyamoya disease in an Asian female in her third decade of life, in whom a bypass recipient vessel was occluded by a white thrombus during surgery and remained occluded on magnetic resonance angiography (MRA) performed up to 6 weeks after the procedure. However, recanalization was confirmed by MRA performed 4 months after surgery. MRA performed 10 and 19 months after surgery revealed that the bypass vessel had grown thicker, and the ischemic symptoms experienced by the patient also improved. Conclusion: Whether this lesion is explained by reopening or angiogenesis, its pathophysiology remains controversial. The uninterrupted connection of occluded bypass vessel in STA-MCA bypass surgery in conjunction with surgical strategy of single bypass using only parietal branch of STA as donor and preserving blood flow of frontal branch to scalp may have made a positive impact on promoting the development of extracranial-intracranial bypass anastomosis in the chronic phase and should be considered.

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“…In these patients, an increased risk of hemorrhagic events was not observed (40). Other data have failed to suggest an association between anti-platelet use and graft patency or ischemic events (40,41). Despite a lack of robust evidence, our institutional protocol typically utilizes low-dose aspirin in patients who have undergone cerebral revascularization, unless otherwise contraindicated.…”

Section: Follow-up Considerations Clinical Managementmentioning

confidence: 95%

Implementation and Rationale for a Unified Clinical and Imaging Protocol for Evaluation and Treatment of Moyamoya Angiopathy: A Single Institutional Experience

et al. 2021

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Moyamoya disease (MMD) is a complex and incompletely-understood cerebrovascular pathological entity that requires thorough clinical and imaging evaluation. Moyamoya is rare, thereby making the establishment of an effective, thorough and interdisciplinary patient evaluation protocol challenging, even within specialized referral centers. Nevertheless, implementation of such a protocol is crucial in order to provide the best possible evaluation and treatment for MMD patients. Here, we describe our institution's implementation of, rationale for, and experience with a comprehensive multidisciplinary collaboration and evaluation strategy for adult patients with moyamoya. This evaluation course consists of, first of all, a thorough clinical and laboratory evaluation with a vascular neurologist. This is followed by a comprehensive imaging assessment which evaluates angiographic and parenchymal features, in addition to cerebrovascular functionality. Finally, appropriate referrals are made to consulting services as indicated, which includes vascular neurosurgery. These steps are described in detail herein.

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Predictive factors for acute thrombogenesis occurring immediately after bypass procedure for moyamoya disease

Cited by 19 publications

References 33 publications

Safety, Feasibility, and Patient-Rated Outcome of Sonolucent Cranioplasty in Extracranial-Intracranial Bypass Surgery to Allow for Transcranioplasty Ultrasound Assessment

Safety, Feasibility, and Patient-Rated Outcome of Sonolucent Cranioplasty in Extracranial-Intracranial Bypass Surgery to Allow for Transcranioplasty Ultrasound Assessment

Delayed reopening of a superficial temporal artery to middle cerebral artery bypass graft occluded by a white thrombus during surgery

Implementation and Rationale for a Unified Clinical and Imaging Protocol for Evaluation and Treatment of Moyamoya Angiopathy: A Single Institutional Experience

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