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.
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.
Authors: Eric J Arias; Gavin P Dunn; Chad W Washington; Colin P Derdeyn; Michael R Chicoine; Robert L Grubb; Christopher J Moran; DeWitte T Cross; Ralph G Dacey; Gregory J Zipfel Journal: J Stroke Cerebrovasc Dis Date: 2015-05-09 Impact factor: 2.136
Authors: A N Laiwalla; F Kurth; K Leu; R Liou; J Pamplona; Y C Ooi; N Salamon; B M Ellingson; N R Gonzalez Journal: AJNR Am J Neuroradiol Date: 2017-01-19 Impact factor: 3.825
Authors: Ignazio G Vetrano; Anna Bersano; Isabella Canavero; Francesco Restelli; Gabriella Raccuia; Elisa F Ciceri; Giuseppe Faragò; Andrea Gioppo; Morgan Broggi; Marco Schiariti; Laura Gatti; Paolo Ferroli; Francesco Acerbi Journal: J Clin Med Date: 2021-05-25 Impact factor: 4.241
Authors: Brendan Ryu; Timothy G White; Kevin A Shah; Justin Turpin; Thomas Link; Amir R Dehdashti; Jeffrey M Katz; Karen Black; Henry H Woo Journal: Interv Neuroradiol Date: 2021-08-04 Impact factor: 1.764