Abstract TMP41: Predictors Of Effective Indirect Bypass In Adult Moyamoya Disease
Background — Indirect bypass for moyamoya disease provides quite effective collaterals in most of pediatric cases, but in only a half of adult cases. However, the predictors for effective indirect bypass in adult cases are still unclear. This study was aimed to evaluate the factor that predicts the effectiveness of indirect bypass in adult moyamoya disease.
Subjects and Methods — This study included totally 26 adult patients (39 sides) who underwent STA-MCA anastomosis and EDMAPS (encephalo-duro-myo-arterio-pericranial synangiosis) since 2000 in Hokkaido University Hospital. There were 6 males and 20 females. Their age ranged from 30 to 71 years. Clinical diagnosis was TIA/cerebral infarct in 30 sides, intracranial hemorrhage in 6, and asymptomatic in 3. Cerebral hemodynamics and metabolism were measured with 123I-IMP SPECT and 15O-gas PET before and after surgery. On postoperative cerebral angiography, the development of indirect bypass was judged as good, when it covers more than 2/3 in the MCA territory. Uni- and multivariate analysis was employed to extract the predictors for the well-developed indirect bypass.
Results — The development of indirect bypass was judged as good in 21 (53.8%) of 39 sides on postoperative cerebral angiography. Univariate analysis revealed that the advanced stage (p=0.018), ischemic onset (p=0.014), low cerebral blood flow (p=0.022) were significant predictors for good indirect bypass. Multivariate analysis demonstrated that the advanced stage on preoperative cerebral angiography can predict the good development of indirect bypass (p=0.025, OR=2.314, 95% CI=1.110~4.824).
Conclusions — These findings strongly suggest that indirect bypass may provide effective surgical collaterals through indirect bypass in adult patients with advanced stage of moyamoya disease.
- © 2012 by American Heart Association, Inc.