Combined Direct and Indirect Bypass for Moyamoya: Quantitative Assessment of Direct Bypass Flow Over Time
Combined Direct and Indirect Bypass for Moyamoya: Quantitative Assessment of Direct Bypass Flow Over Time
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DOI：
10.1227/neu.0000000000000139
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发表时间：
2013-12-01
期刊：
影响因子：
4.8
通讯作者：
Charbel, Fady T.
中科院分区：
文献类型：
--
作者：
Amin-Hanjani, Sepideh;Singh, Amritha;Charbel, Fady T.
BACKGROUND: The optimal revascularization strategy for symptomatic adult moyamoya remains controversial. Whereas direct bypass offers immediate revascularization, indirect bypass can effectively induce collaterals over time.OBJECTIVE: Using angiography and quantitative magnetic resonance angiography, we examined the relative contributions of direct and indirect bypass in moyamoya patients after combined direct superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass and indirect encephaloduroarteriosynangiosis (EDAS).METHODS: A retrospective review of moyamoya patients undergoing combined STA-MCA bypass and EDAS was conducted, excluding pediatric patients and hemorrhagic presentation. Patients with quantitative magnetic resonance angiography measurements of the direct bypass immediately and. 6 months postoperatively were included. Angiographic follow-up, when available, was used to assess EDAS collaterals at similar time intervals.RESULTS: Of 16 hemispheres in 13 patients, 11 (69%) demonstrated a significant (> 50%) decline in direct bypass flow at > 6 months compared with baseline, averaging a drop from 99 +/- 35 to 12 +/- 7 mL/min. Conversely, angiography in these hemispheres demonstrated prominent indirect collaterals, in concert with shrinkage of the STA graft. Decline in flow was apparent at a median of 9 months but was evident as early as 2 to 3 months.CONCLUSION: In this small cohort, a reciprocal relationship between direct STA bypass flow and indirect EDAS collaterals frequently occurred. This substantiates the notion that combined direct/indirect bypass can provide temporally complementary revascularization.
