Satoshi Hori1, Güliz Acker1, Peter Vajkoczy2. 1. Department of Neurosurgery, Universitätsmedizin Charite, Berlin, Germany. 2. Department of Neurosurgery, Universitätsmedizin Charite, Berlin, Germany. Electronic address: peter.vajkoczy@charite.de.
Abstract
BACKGROUND: Failure of direct revascularization with superficial temporal artery (STA)-middle cerebral artery (MCA) bypass for Moyamoya disease (MMD) is comparatively rare. However, for those cases where a bypass fails to prevent further ischemic attacks, safe and efficient rescue strategies are needed. We present our experience with radial artery grafts for secondary revascularization of MMD. METHODS: Between April 2007 and April 2014, we have performed STA-MCA bypass in 182 patients diagnosed with Moyamoya vasculopathy. Four patients with typical MMD who had an unsuccessful STA-MCA bypass required additional revascularization because they remained symptomatic. Digital subtraction angiography revealed delayed STA graft failure in these patients, who continued to have transient ischemic attacks after the initial surgery. Cerebral blood flow studies confirmed persistent impairment of cerebrovascular reserve capacity. As an escape strategy, we performed radial artery graft bypass surgery from the external carotid artery to the M2 or M3 portion of the MCA. RESULTS: The median duration between the 2 surgeries was 10 months. The mean follow-up period after rescue revascularization was 8.5 ± 3.3 months. Revascularization with the radial artery graft was successful in all cases without perioperative complications. Postoperatively, none of the patients experienced further cerebrovascular events. After 3 months, digital subtraction angiography revealed patent radial artery grafts and adequate revascularization in 3 patients; 1 patient presented with bypass graft failure but had developed transdural collateral vessels contributing to the filling of the cerebral vasculature. CONCLUSIONS: Rescue bypass with a radial artery graft provides a useful function. Although delayed graft failure may occur, this procedure is successful if the patients remain symptom free with the development of collateral flow.
BACKGROUND: Failure of direct revascularization with superficial temporal artery (STA)-middle cerebral artery (MCA) bypass for Moyamoya disease (MMD) is comparatively rare. However, for those cases where a bypass fails to prevent further ischemic attacks, safe and efficient rescue strategies are needed. We present our experience with radial artery grafts for secondary revascularization of MMD. METHODS: Between April 2007 and April 2014, we have performed STA-MCA bypass in 182 patients diagnosed with Moyamoya vasculopathy. Four patients with typical MMD who had an unsuccessful STA-MCA bypass required additional revascularization because they remained symptomatic. Digital subtraction angiography revealed delayed STA graft failure in these patients, who continued to have transient ischemic attacks after the initial surgery. Cerebral blood flow studies confirmed persistent impairment of cerebrovascular reserve capacity. As an escape strategy, we performed radial artery graft bypass surgery from the external carotid artery to the M2 or M3 portion of the MCA. RESULTS: The median duration between the 2 surgeries was 10 months. The mean follow-up period after rescue revascularization was 8.5 ± 3.3 months. Revascularization with the radial artery graft was successful in all cases without perioperative complications. Postoperatively, none of the patients experienced further cerebrovascular events. After 3 months, digital subtraction angiography revealed patent radial artery grafts and adequate revascularization in 3 patients; 1 patient presented with bypass graft failure but had developed transdural collateral vessels contributing to the filling of the cerebral vasculature. CONCLUSIONS: Rescue bypass with a radial artery graft provides a useful function. Although delayed graft failure may occur, this procedure is successful if the patients remain symptom free with the development of collateral flow.
Authors: Markus Kraemer; Jasmin Sassen; Rusen Karakaya; Jan Claudius Schwitalla; Jonas Graf; Philipp Albrecht; Hans-Peter Hartung; Rolf R Diehl; Peter Berlit; Rudolf Laumer; Frank Diesner Journal: J Neurol Date: 2018-08-17 Impact factor: 4.849
Authors: R Mertens; M Graupera; H Gerhardt; A Bersano; E Tournier-Lasserve; M A Mensah; S Mundlos; P Vajkoczy Journal: Transl Stroke Res Date: 2021-09-16 Impact factor: 6.829