A novel system for evaluating collateralization of the external carotid artery after cerebral revascularization in moyamoya disease.

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  • Additional Information
    • Source:
      Publisher: American Association of Neurological Surgeons Country of Publication: United States NLM ID: 0253357 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1933-0693 (Electronic) Linking ISSN: 00223085 NLM ISO Abbreviation: J Neurosurg Subsets: MEDLINE
    • Publication Information:
      Publication: Charlottesville, VA : American Association of Neurological Surgeons
      Original Publication: Chicago [etc.]
    • Subject Terms:
      Moyamoya Disease*/surgery ; Moyamoya Disease*/diagnostic imaging ; Cerebral Revascularization*/methods ; Collateral Circulation*/physiology ; Angiography, Digital Subtraction* ; Carotid Artery, External*/surgery ; Carotid Artery, External*/diagnostic imaging; Humans ; Male ; Female ; Retrospective Studies ; Adult ; Child ; Middle Aged ; Adolescent ; Young Adult ; Child, Preschool ; Treatment Outcome ; Neovascularization, Physiologic
    • Abstract:
      Objective: The objective of this retrospective study was to establish a novel system for evaluating collateralization of the external carotid artery in patients with moyamoya disease (MMD) following direct and indirect revascularization surgeries.
      Methods: The authors conducted a retrospective analysis of 456 patients diagnosed with MMD who underwent direct and indirect revascularization procedures at Beijing Tiantan Hospital, Capital Medical University, between January 2015 and May 2023. Using a newly proposed digital subtraction angiography (DSA)-based evaluation system, the authors assessed collateralization angiogenesis objectively and in a standardized manner.
      Results: The authors' findings indicated that there was no significant difference in collateralization angiogenesis between patients undergoing direct or indirect cerebral revascularization (p = 0.702). However, after cerebral revascularization, patients with ischemic MMD exhibited significantly higher collateralization angiogenesis compared with those with hemorrhagic MMD (p = 0.007). Children with MMD demonstrated higher angiogenesis levels than adults (p < 0.001), but subgroup analysis showed age-specific variations. In adults, collateralization angiogenesis was significantly greater in those with ischemic MMD (p = 0.006), whereas in children, no significant difference was noted between ischemic and hemorrhagic MMD (p = 0.962). Furthermore, regardless of MMD type, direct and indirect revascularization methods yielded similar collateralization angiogenesis (p = 0.962 and p = 0.963, respectively). Importantly, the Matsushima grading system revealed significant differences in angiogenesis in patients with ischemic MMD (p < 0.001).
      Conclusions: The newly introduced DSA-based evaluation system offers an objective and standardized method for assessing collateralization angiogenesis in MMD. This study supports the efficacy of both direct and indirect revascularization surgical procedures and highlights distinct pathophysiological processes of ischemic and hemorrhagic disease subtypes. These findings contribute to a better understanding of surgical outcomes and aid in the selection of appropriate treatment strategies for patients with MMD.
    • Contributed Indexing:
      Keywords: DSA-based evaluation system; cerebral revascularization; digital subtraction angiography; external carotid artery collateralization; moyamoya disease; vascular disorders
    • Publication Date:
      Date Created: 20231229 Date Completed: 20240601 Latest Revision: 20240601
    • Publication Date:
      20240602
    • Accession Number:
      10.3171/2023.10.JNS231660
    • Accession Number:
      38157529