Clinical Characteristics of Immediate Contralateral Ischemia Subsequent to Revascularization for Moyamoya Disease

Moyamoya disease is a bilateral steno-occlusive disease involving the cerebral vasculature. While some patients are affected by procedure-related ipsilateral ischemia, ischemic complications contralateral to the revascularization are rarely observed. We retrospectively investigated 135 hemispheres (...

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Bibliographic Details
Published in:World neurosurgery 2024-03, Vol.183, p.e355-e365
Main Authors: Sato, Daisuke, Miyawaki, Satoru, Imai, Hideaki, Hongo, Hiroki, Kiyofuji, Satoshi, Koizumi, Satoshi, Saito, Nobuhito
Format: Article
Language:English
Subjects:
Adenosine Triphosphatases
Adult
Aged
Cerebral Revascularization - methods
Contralateral ischemic complication
Female
Hemodynamic insufficiency
Humans
Infarction
Internal carotid artery total occlusion
Intracranial blood flow redistribution
Ischemia - complications
Middle Aged
Moyamoya disease
Moyamoya Disease - complications
Moyamoya Disease - diagnostic imaging
Moyamoya Disease - surgery
Retrospective Studies
Revascularization
Ubiquitin-Protein Ligases
Citations: Items that this one cites
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Summary:Moyamoya disease is a bilateral steno-occlusive disease involving the cerebral vasculature. While some patients are affected by procedure-related ipsilateral ischemia, ischemic complications contralateral to the revascularization are rarely observed. We retrospectively investigated 135 hemispheres (103 patients) that underwent revascularization in our institution between April 2006 and September 2022. Revascularization surgery comprised single superficial temporal artery-middle cerebral artery anastomosis and encephalo-myo-synangiosis. Certain patients aged under 10 years underwent indirect revascularization. Bilateral revascularization was performed with an interval of >3 months. Medical records and neuroimages were reviewed, and patients with contralateral ischemic complications were identified. Some cases underwent genetic analysis. The mean age was 34.5 (range: 5–71) years, and 95 cases (70.4%) were in women. Of the 102 cases examined for the RNF213 c.14429 G > A (p.Arg4810Lys) variant, 33 (32.4%) and 69 (67.6%) showed the GG and GA genotype, respectively. Three cases (2.2%, all female, age range 44–71 years) were complicated with contralateral infarction. The infarcted area distributions of the 2 cases with RNF213 c.14429 G > A variant were patchy and peripheral. The other case showed on magnetic resonance imaging (MRI) angiography total occlusion of the internal carotid artery where patency had been confirmed preoperatively. Contralateral ischemia after revascularization occurred in 2.2% of cases. We classified them into peripheral and central types: peripheral type, an infarction owing to hemodynamic insufficiency or intracranial blood flow redistribution; central type, total occlusion of the contralateral internal carotid artery. Intensive preoperative management can minimize the risk of peripheral types, and neurosurgeons should beware of severe central types.
ISSN:1878-8750
1878-8769
1878-8769
DOI:10.1016/j.wneu.2023.12.100