Changes in periventricular anastomosis after indirect revascularization surgery alone for adult patients with misery perfusion due to ischemic moyamoya disease.
Changes in periventricular anastomosis after indirect revascularization surgery alone for adult patients with misery perfusion due to ischemic moyamoya disease.
复制标题
因缺血性烟雾病导致灌注痛苦的成年患者单独进行间接血运重建手术后脑室周围吻合术的变化。
DOI：
10.1007/s10143-022-01861-w
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发表时间：
2022
期刊：
影响因子：
2.8
通讯作者：
Ogasawara K.
中科院分区：
文献类型：
--
作者：
Kobayashi M;Akamatsu Y;Chida K;Uchida S;Fujiwara S;Yoshida K;Koji T;Kubo Y;Ogasawara K.
烟雾病脑室周围吻合是一种罕见的血管造影发现，起源于穿支动脉，如延髓纹动脉（LSA），丘脑动脉（THA）和脉络膜前动脉（AChA）。这种吻合与MMD出血风险增加相关，可以通过直接血运重建手术纠正。本前瞻性队列的补充分析旨在阐明因缺血性MMD导致灌注不良的成人患者单独进行间接血运重建手术后脑室周围吻合的变化。22例仅接受间接血运重建手术的症状性大脑半球灌注不良的患者在手术前和术后6个月也通过动脉插管进行了六血管脑血管造影。手术前，2例患者（9%）的LSA脑室周围吻合阳性，另1例患者（5%）的AChA脑室周围吻合阳性;所有3例脑室周围吻合在手术后均消退，但这些变化无统计学意义（p= 0.0833）。术后LSA侧支血管形成程度显著降低（p= 0.0143），但THA或AChA侧支血管形成程度在术前和术后之间无差异。8例术后任何穿支动脉侧支血管消退的患者显示间接血运重建术后侧支血流丰富。单纯间接血运重建术治疗缺血性MMD灌注不良的成人患者，脑室周围吻合术有退化的趋势。对于此类患者，单独进行间接血运重建手术后，由LSA形成的侧支血管可能会消退，但THA或AChA形成的侧支血管很少发生变化。
Periventricular anastomosis in moyamoya disease (MMD) is an unusual angiographic finding that arises from perforating arteries such as the lenticulostriate artery (LSA), thalamic artery (THA), and anterior choroidal artery (AChA). This anastomosis is associated with increased hemorrhagic risk in MMD and can be corrected by direct revascularization surgery. The present supplementary analysis on a prospective cohort aimed to elucidate changes in periventricular anastomosis after indirect revascularization surgery alone for adult patients with misery perfusion due to ischemic MMD. Twenty-two patients with misery perfusion in the symptomatic cerebral hemisphere who underwent indirect revascularization surgery alone also underwent six-vessel cerebral angiography via arterial catheterization before and at 6 months after surgery. Before surgery, two patients (9%) had positive periventricular anastomosis from the LSA and another (5%) from the AChA; all three of these periventricular anastomoses regressed after surgery, but these changes were not statistically significant (p= 0.0833). The degree of formation of collateral vessels from the LSA significantly decreased after surgery (p= 0.0143), but the degree of collateral vessels from the THA or AChA did not differ between pre- and postoperative conditions. Eight patients with postoperative regression of the collateral vessels from any perforating artery exhibited postoperative rich collateral flow from indirect revascularization. Periventricular anastomosis tended to regress after indirect revascularization surgery alone for adult patients with misery perfusion due to ischemic MMD. Collateral vessels formed from the LSA likely regressed after indirect revascularization surgery alone for such patients, but those vessels from the THA or AChA seldom changed.