Asunto(s)
Revascularización Cerebral , Aneurisma Intracraneal , Humanos , Aneurisma Intracraneal/cirugía , Aneurisma Intracraneal/diagnóstico por imagen , Revascularización Cerebral/métodos , Cerebelo/irrigación sanguínea , Cerebelo/cirugía , Cerebelo/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Persona de Mediana Edad , Masculino , Femenino , Arteria Vertebral/cirugía , Arteria Vertebral/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Unruptured giant intracranial aneurysms (GIA) are those with diameters of 25 mm or greater. As aneurysm size is correlated with rupture risk, GIA natural history is poor. Parent artery occlusion or trapping plus bypass revascularization should be considered to encourage intra-aneurysmal thrombosis when other treatment options are contraindicated. The mechanistic background of these methods is poorly studied. Thus, we assessed the potential of computational fluid dynamics (CFD) and fluid-structure interaction (FSI) analyses for clinical use in the preoperative stage. A CFD investigation in three patient-specific flexible models of whole arterial brain circulation was performed. A C6 ICA segment GIA model was created based on CT angiography. Two models were then constructed that simulated a virtual bypass in combination with proximal GIA occlusion, but with differing middle cerebral artery (MCA) recipient vessels for the anastomosis. FSI and CFD investigations were performed in three models to assess changes in flow pattern and haemodynamic parameters alternations (wall shear stress (WSS), oscillatory shear index (OSI), maximal time averaged WSS (TAWSS), and pressure). General flow splitting across the entire domain was affected by virtual bypass procedures, and any deficiency was partially compensated by a specific configuration of the circle of Willis. Following the implementation of bypass procedures, a reduction in haemodynamic parameters was observed within the aneurysm in both cases under analysis. In the case of the temporal MCA branch bypass, the decreases in the studied parameters were slightly greater than in the frontal MCA branch bypass. The reduction in the magnitude of the chosen area-averaged parameters (averaged over the aneurysm wall surface) was as follows: WSS 35.7%, OSI 19.0%, TAWSS 94.7%, and pressure 24.2%. FSI CFD investigation based on patient-specific anatomy models with subsequent stimulation of virtual proximal aneurysm occlusion in conjunction with bypass showed that this method creates a pro-thrombotic favourable environment whilst reducing intra-aneurysmal pressure leading to shrinking. MCA branch recipient selection for optimum haemodynamic conditions should be evaluated individually in the preoperative stage.
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Hemodinámica , Hidrodinámica , Aneurisma Intracraneal , Aneurisma Intracraneal/cirugía , Aneurisma Intracraneal/fisiopatología , Aneurisma Intracraneal/diagnóstico por imagen , Humanos , Simulación por Computador , Arteria Cerebral Media/cirugía , Arteria Cerebral Media/fisiopatología , Arteria Cerebral Media/diagnóstico por imagen , Circulación Cerebrovascular/fisiología , Masculino , Modelos Cardiovasculares , Persona de Mediana Edad , Angiografía Cerebral , Angiografía por Tomografía Computarizada , Revascularización Cerebral/métodosRESUMEN
BACKGROUND: Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive steno-occlusive changes in the internal carotid arteries, leading to an abnormal vascular network. Hypertension is prevalent among MMD patients, raising concerns about its impact on disease outcomes. This study aims to compare the clinical characteristics and outcomes of MMD patients with and without hypertension. METHODS: We conducted a multicenter, retrospective study involving 598 MMD patients who underwent surgical revascularization across 13 academic institutions in North America. Patients were categorized into hypertensive (n=292) and non-hypertensive (n=306) cohorts. Propensity score matching (PSM) was performed to adjust for baseline differences. RESULTS: The mean age was higher in the hypertension group (46 years vs. 36.8 years, p < 0.001). Hypertensive patients had higher rates of diabetes mellitus (45.2% vs. 10.7%, p < 0.001) and smoking (48.8% vs. 27.1%, p < 0.001). Symptomatic stroke rates were higher in the hypertension group (16% vs. 7.1%; OR: 2.48; 95% CI: 1.39-4.40, p = 0.002) before matching. After PSM, there were no significant differences in symptomatic stroke rates (11.1% vs. 7.7%; OR: 1.5; CI: 0.64-3.47, p = 0.34), perioperative strokes (6.2% vs. 2.1%; OR 3.13; 95% CI: 0.83-11.82, p = 0.09), or good functional outcomes at discharge (93% vs. 92.3%; OR 1.1; 95% CI: 0.45-2.69, p = 0.82). CONCLUSION: No significant differences in symptomatic stroke rates, perioperative strokes, or functional outcomes were observed between hypertensive and non-hypertensive Moyamoya patients. Appropriate management can lead to similar outcomes in both groups. Further prospective studies are required to validate these findings.
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Hipertensión , Enfermedad de Moyamoya , Puntaje de Propensión , Humanos , Enfermedad de Moyamoya/cirugía , Enfermedad de Moyamoya/complicaciones , Femenino , Masculino , Persona de Mediana Edad , Adulto , Hipertensión/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento , Accidente Cerebrovascular/etiología , Revascularización Cerebral/métodosRESUMEN
BACKGROUND: Cerebral Revascularization (CR) remained an indispensable arm in the neurosurgical arsenal, especially managing symptomatic hemisphere with misery perfusion (SHMP). METHOD: We described an a mid-aged gentleman diagnosed with progressive middle cerebral steno-occlusion following carotid endarterectomy by employing individualized arterial reconstruction with tentative clamping method (TCM) under supervision of intraoperative monitoring. An operative video was also accompanied to demonstrate further details. CONCLUSION: The optimal treatment strategy for SHMP should be tailored by individuals. The risk of postoperative adverse sequel can be minimized and improved neuro-cognitive status was accomplished with an aid of TCM for such prophylactic procedure. CLINICAL TRIAL REGISTRATION: NA.
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Revascularización Cerebral , Endarterectomía Carotidea , Humanos , Masculino , Persona de Mediana Edad , Estenosis Carotídea/cirugía , Revascularización Cerebral/métodos , Constricción , Endarterectomía Carotidea/métodos , Infarto de la Arteria Cerebral Media/cirugía , Infarto de la Arteria Cerebral Media/diagnóstico por imagenRESUMEN
PURPOSE: Posterior circulation cerebral bypasses often show higher risks and lower patency. Only few reports discussed occipital artery (OA)-vertebral artery (VA) bypasses. We present our illustrative cases to address current gaps in the literature on OA-VA bypass. METHODS: A single-center retrospective review was conducted to include all institutional cases of OA-VA bypass, discussing the technique and outcomes. RESULTS: Four institutional cases undergoing a total of 5 bypasses were evaluated, including 3 males and 1 female, with median age of 65 years (range, 62-73). All patients had vertebrobasilar insufficiency (VBI) with recurrent strokes/TIAs due to intracranial atherosclerosis, leading to unilateral VA stenosis with contralateral occlusion (1, 25%), bilateral VA stenosis (1, 25%) or occlusion (1, 25%). Medical management included aspirin for all cases (100%), with clopidogrel in 3 (75%). Surgery was performed through a far lateral approach, connecting the OA to the VA-3 segment, with no inter-positional graft. One patient underwent contralateral OA-VA bypass 6 months after the prior surgery due to worsening of the contralateral VA stenosis. Bypass patency was confirmed in all cases with post-operative angiography. All patients had clinical improvement, with one case of wound dehiscence managed conservatively. All patients were alive at last follow-up (median 7.0 months; range: 1.5-18). CONCLUSION: OA-VA bypass is a challenging yet effective strategy in selected patients with VBI. Current literature lacks unique definitions of surgical indications and techniques, which we addressed in our series. Surgical education should focus on expanding the microsurgery anatomy knowledge.
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Revascularización Cerebral , Arteria Vertebral , Insuficiencia Vertebrobasilar , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Estudios Retrospectivos , Arteria Vertebral/cirugía , Arteria Vertebral/diagnóstico por imagen , Revascularización Cerebral/métodos , Resultado del Tratamiento , Insuficiencia Vertebrobasilar/cirugía , Insuficiencia Vertebrobasilar/diagnóstico por imagenRESUMEN
BACKGROUND: In adults, moyamoya disease (MMD) often presents with slight neurocognitive impairment, which may result from frontal lobe hemodynamic insufficiency. METHODS: In this study, we performed revascularization surgery by superficial temporal artery-anterior cerebral artery (ACA) direct bypass in 20 adults with MMD with poor anterograde ACA flow (Group M). The pre- and postoperative neurocognitive test results of these patients were retrospectively analyzed. The comparative group (Group C) included 23 patients with unruptured aneurysms or brain tumors who underwent craniotomy, as well as the same neurocognitive tests as Group M. We calculated the compositive frontal lobe function index (CFFI) based on the results of seven neurocognitive tests for each patient, and the difference between the pre- and postoperative CFFI values (CFFI Post - Pre) was compared between the two groups. RESULTS: Frontal perfusion improved postoperatively in all patients in Group M. The CFFI Post - Pre was significantly higher in Group M than in Group C (0.23 ± 0.44 vs. - 0.20 ± 0.32; p < 0.001). After adjusting for postoperative age, sex, preoperative non-verbal intelligence quotient, and preoperative period of stress, Group M had a significantly higher CFFI Post - Pre than Group C in the multiple regression analysis (t value = 4.01; p < 0.001). CONCLUSION: Improving frontal lobe hemodynamics might be the key for improving neurocognitive dysfunction in adults with MMD. The surgical indication and method should be considered from the perspective of both stroke prevention and neurocognitive improvement or protection.
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Revascularización Cerebral , Lóbulo Frontal , Hemodinámica , Enfermedad de Moyamoya , Pruebas Neuropsicológicas , Humanos , Enfermedad de Moyamoya/cirugía , Enfermedad de Moyamoya/complicaciones , Femenino , Masculino , Adulto , Lóbulo Frontal/cirugía , Persona de Mediana Edad , Revascularización Cerebral/métodos , Hemodinámica/fisiología , Estudios Retrospectivos , Resultado del Tratamiento , Arteria Cerebral Anterior/cirugía , Adulto Joven , Circulación Cerebrovascular/fisiologíaRESUMEN
BACKGROUND: Training in anastomosis is fundamental in neurosurgery due to the precision and dexterity required. Biological models, although realistic, present limitations such as availability, ethical concerns, and the risk of biological contamination. Synthetic models, on the other hand, offer durability and standardized conditions, although they sometimes lack anatomical realism. This study aims to evaluate and compare the efficiency of anastomosis training models in the intra-extracranial cerebral bypass procedure, identifying those characteristics that enhance optimal microsurgical skill development and participant experience. METHODS: A neurosurgery workshop was held from March 2024 to June 2024 with 5 vascular techniques and the participation of 22 surgeons. The models tested were the human placenta, the Wistar rat, the chicken wing artery, the nasogastric feeding tube, and the UpSurgeOn Mycro simulator. The scales used to measure these models were the Main Characteristics Score and the Evaluation Score. These scores allowed us to measure, qualitatively and quantitatively, durability, anatomical similarity, variety of simulation scenarios, risk of biological contamination, ethical considerations and disadvantages with specific infrastructure. RESULTS: The human placenta model, Wistar rat model, and UpSurgeOn model were identified as the most effective for training. The human placenta and Wistar rat models were highly regarded for anatomical realism, while the UpSurgeOn model excelled in durability and advanced simulation scenarios. Ethical and cost implications were also considered. CONCLUSIONS: The study identifies the human placenta and UpSurgeOn models as optimal for training in intra-extracranial bypass procedures, emphasizing the need for diverse and effective training models in neurosurgery.
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Competencia Clínica , Procedimientos Neuroquirúrgicos , Ratas Wistar , Animales , Humanos , Ratas , Procedimientos Neuroquirúrgicos/educación , Procedimientos Neuroquirúrgicos/métodos , Neurocirugia/educación , Femenino , Placenta/cirugía , Revascularización Cerebral/métodos , Revascularización Cerebral/educación , Microcirugia/educación , Microcirugia/métodos , Embarazo , Anastomosis Quirúrgica/educación , Anastomosis Quirúrgica/métodos , Pollos , Modelos Anatómicos , Entrenamiento Simulado/métodos , Modelos AnimalesRESUMEN
BACKGROUND: There are barely any alternative treatment options to the drug treatment of hemodynamically caused cerebral ischemia, as in occlusion of the internal carotid artery. OBJECTIVE: For secondary prevention of an ischemic stroke due to carotid occlusion and hemodynamic instability, extracranial-intracranial (EC-IC) bypass surgery can be an important option in selected patients. MATERIAL AND METHODS: The development, study situation, indications and surgical technique for placement of an EC-IC bypass in cases of occlusion of the internal carotid artery are presented. RESULTS: With appropriate expertise and strict selection of patients, the placement of an EC-IC bypass enables stabilization of cerebral perfusion with a low rate of complications. CONCLUSION: The study situation is controversially discussed; nevertheless, surgical treatment in a specialized neurovascular center should at least be considered.
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Arteria Carótida Interna , Estenosis Carotídea , Revascularización Cerebral , Humanos , Estenosis Carotídea/cirugía , Revascularización Cerebral/métodos , Arteria Carótida Interna/cirugíaRESUMEN
Decreased cerebral blood flow (CBF) leads to impaired cerebral hemodynamics, which causes an increased risk of stroke. Revascularization has been shown to improve CBF in patients with moyamoya disease. The study is devoted to the retrospective study of clinical features and cerebral hemodynamic characteristics of 17 patients with moyamoya disease before, during and after surgical treatment using extracranial-intracranial (EC-IC) bypass by STA-MCA type. Patients underwent superficial temporal artery-middle cerebral artery bypass surgeries. All patients were carried out by DSA, MSCT-angiography, and MSCT-perfusion imagine (MSCTPI) before and 6 months after surgery. The hemodynamic parameters during MSCTPI, changes in cerebral vascular pattern, and clinical outcomes were evaluated. Cerebral blood flow and mean transit time (MTT) were measured using MSCT-perfusion imaging to identify areas of hypoperfusion. Intraoperative indocyanine green (ICG) analysis was performed to assess local cerebral hemodynamics before and after the creation of the STA-MCA bypass. Results showed that hemodynamics improved significantly on the surgery side after revascularization. After STA-MCA bypass CBF increased and MTT reduced by almost 2 times compared to the level before the bypass. The modified Rankin Scale scores demonstrated an improvement in the neurological status of patients following surgical revascularization. Thus, STA-MCA-type surgical revascularization significantly improved cerebral perfusion parameters and reduced the risk of stroke in patients with moyamoya disease. MSCTPI can serve as an effective and noninvasive method for monitoring cerebral hemodynamics in these patients. Intraoperative ICG angiography is a safe method that can display hemodynamic characteristics in the surgical area.
Asunto(s)
Revascularización Cerebral , Circulación Cerebrovascular , Hemodinámica , Enfermedad de Moyamoya , Accidente Cerebrovascular , Humanos , Enfermedad de Moyamoya/cirugía , Enfermedad de Moyamoya/diagnóstico por imagen , Enfermedad de Moyamoya/fisiopatología , Femenino , Masculino , Revascularización Cerebral/métodos , Circulación Cerebrovascular/fisiología , Adulto , Accidente Cerebrovascular/cirugía , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Persona de Mediana Edad , Estudios Retrospectivos , Arteria Cerebral Media/cirugía , Arteria Cerebral Media/diagnóstico por imagen , Arteria Cerebral Media/fisiopatología , Adolescente , Adulto Joven , Arterias Temporales/cirugía , Arterias Temporales/diagnóstico por imagen , Angiografía Cerebral , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: Posterior cerebral artery involvement (PCAi) has been identified as an important factor related to poor prognosis in moyamoya disease (MMD). This study summarized the characteristics of children with MMD and PCAi, clarified the clinical course, identified prognostic predictors, and investigated the long-term effect of encephaloduroarteriosynangiosis for posterior circulation (EDAS-p). METHODS: We retrospectively reviewed all our pediatric MMD cases with follow-up angiograms from November 2003 to December 2016. PCAi was classified as early-onset at initial diagnosis and delayed-onset after anterior circulation revascularization. Multivariable data including clinical features, radiographic findings, and surgical outcomes were analyzed. RESULTS: Among 570 children with MMD, 246 (43.2%) had PCAi, with 176 (30.9%) classified as early-onset PCAi. During a median follow-up period of 10 years, 17.8% (70/394) of patients without initial PCAi developed delayed-onset PCAi. The median time to detection of a new PCA lesion was 15.5 (range 7-110) months from initial diagnosis, with a median age of 10.5 (3-22). Younger age at onset, familial occurrence, advanced Suzuki stages, and preoperative infarctions were predictors of delayed-onset PCAi. EDAS-p was performed on 294 hemispheres of 195 patients with PCAi. Stroke-free survival was significantly higher in the EDAS-p group than in the non-EDAS-p group (99.0% vs 90.2%; p < 0.001 [Breslow test]; p = 0.001 [log-rank test]; median follow-up: 101 months). DISCUSSION: PCAi is not uncommon in children with MMD, underscoring the need for long-term close clinical monitoring, especially in patients with high-risk factors for PCA progression. EDAS-p may be a safe and effective procedure for preventing subsequent stroke in children with MMD and PCAi.
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Enfermedad de Moyamoya , Arteria Cerebral Posterior , Humanos , Enfermedad de Moyamoya/diagnóstico por imagen , Enfermedad de Moyamoya/complicaciones , Enfermedad de Moyamoya/cirugía , Enfermedad de Moyamoya/terapia , Masculino , Niño , Femenino , Estudios Retrospectivos , Preescolar , Adolescente , Arteria Cerebral Posterior/diagnóstico por imagen , Resultado del Tratamiento , Revascularización Cerebral/métodos , Estudios de Seguimiento , Adulto Joven , Lactante , PronósticoRESUMEN
BACKGROUND AND OBJECTIVES: STA-MCA bypass surgery is mainly used for Moyamoya disease, giant intracranial aneurysms, and resection of intracranial tumors requiring sacrifice of blood vessels. The intraoperative patency of the reconstructive vessels is critical to the efficacy of the procedure. This study aimed to evaluate the efficacy of intra-arterially infused tirofiban for the treatment of acute thrombosis during STA-MCA bypass surgery and countermeasures for acute thrombosis. METHODS: This study involved 209 patients (272 hemispheres) who underwent STA-MCA surgery between November 2020 and December 2023. Intraoperative acute thrombosis occurred in eight patients (3.83%,8 hemispheres). We retrospectively reviewed the clinical and imaging data, surgical procedure, and follow-up outcomes of eight patients. We implemented the different thrombolytic methods to evaluate the optimal thrombosis management during the bypass surgery. After three months, we assessed neurological functions using the modified Rankin Scale (mRS) and conducted a literature review using PubMed. RESULTS: Eight patients (four male patients and four female patients) developed acute thrombosis during the bypass surgery. Of the eight patients, two underwent re-anastomosis after thrombus removal, three received local injections of tirofiban into the anastomosis or the branches of the superficial temporal artery, and three underwent superselective intra-arterial tirofiban infusion using a microcatheter. Thrombosis were resolved, and arteries were recanalized in all patients. The mRS score was 0 in all patients. No major ischemic or hemorrhagic complications occurred. CONCLUSION: Our treatment methods were efficacious in the management of acute thrombosis. Intra-arterial tirofiban administration seems to be a simple and effective treatment option for acute thrombosis during STA-MCA bypass surgery.
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Revascularización Cerebral , Tirofibán , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Revascularización Cerebral/métodos , Revascularización Cerebral/efectos adversos , Tirofibán/uso terapéutico , Tirofibán/administración & dosificación , Estudios Retrospectivos , Arterias Temporales/cirugía , Arteria Cerebral Media/cirugía , Trombosis/etiología , Fibrinolíticos/uso terapéutico , Complicaciones Intraoperatorias/etiología , Resultado del Tratamiento , Terapia Trombolítica/métodosRESUMEN
The horizontal part of the third segment (V3) of the vertebral artery (VA) is a critical anastomotic site for bypass procedures involving either donor or recipient vessels. It is rare for the V3 segment to deviate from its typical course of passing through the atlanto-transverse foramen. V3 anomaly encountered in occipital artery (OA)-V3 bypass surgery has not been previously reported. Here, we present a case involving a patient undergoing bypass surgery due to recurrent post-stent occlusion at the first segment (V1) of the left VA. During the operation, it was noted that the V3 horizontal segment could not be identified within the left VA groove, leading to initial suspicion of left V3 disuse atrophy attributed to prolonged chronic ischaemia. Consequently, there was a need to modify the operative method and to transition from an OA-V3 bypass to an OA-posterior inferior cerebellar artery bypass. Post-operative computed tomography angiography confirmed that indeed, the left V3 did not traverse through the transverse foramen of the atlas and instead entered the dural membrane between the first cervical vertebra (C1) and the second cervical vertebra (C2).
Asunto(s)
Arteria Vertebral , Humanos , Arteria Vertebral/anomalías , Arteria Vertebral/diagnóstico por imagen , Arteria Vertebral/cirugía , Revascularización Cerebral/métodos , Masculino , Angiografía por Tomografía Computarizada , Persona de Mediana Edad , Stents , FemeninoRESUMEN
BACKGROUND: This study investigated the long-term clinical and angiographic outcomes of encephaloduroarteriosynangiosis treatment for symptomatic intracranial atherosclerotic arterial steno-occlusive disease to further evaluate the potential therapeutic role of encephaloduroarteriosynangiosis in this population. METHODS AND RESULTS: A total of 152 adult patients with symptomatic intracranial atherosclerotic arterial steno-occlusive disease who were treated with encephaloduroarteriosynangiosis and intensive medical management across 3 tertiary centers in China between January 2011 and September 2019 were retrospectively included. The primary outcomes were defined as postoperative cerebrovascular events, including ischemic and hemorrhagic stroke. The postoperative neovascularization was analyzed qualitatively and quantitatively by using angiography. Clinical, radiological, and long-term follow-up data were analyzed using Cox regression, logistic regression, and linear regression analyses. Primary outcome rates were 3.2% (5/152) within 30 days, 6.6% (10/152) within 2 years, 9.2% (14/152) within 5 years, and 11.1% (17/152) during a median 9.13 years follow-up. Initial infarction symptoms were positively associated with recurrent ischemic stroke. Additionally, posterior circulation involvement and coexisting cardiac disease indicated poorer neurological status, whereas encephaloduroarteriosynangiosis neovascularization efficacy was negatively associated with older age and vascular risk factors but positively associated with posterior circulation involvement. CONCLUSIONS: Encephaloduroarteriosynangiosis plus intensive medical management appears efficacious and safe for symptomatic intracranial atherosclerotic arterial steno-occlusive disease, with low perioperative risk and favorable long-term results. Further prospective trials are needed to verify its efficacy and determine the optimal patient selection criteria.
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Arteriosclerosis Intracraneal , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Arteriosclerosis Intracraneal/diagnóstico por imagen , Arteriosclerosis Intracraneal/complicaciones , Arteriosclerosis Intracraneal/terapia , Resultado del Tratamiento , Anciano , China/epidemiología , Angiografía Cerebral/métodos , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Accidente Cerebrovascular Isquémico/etiología , Adulto , Factores de Tiempo , Revascularización Cerebral/métodos , Factores de RiesgoRESUMEN
INTRODUCTION: Conventionally, one branch of the superficial temporal artery (STA) is utilized to revascularize the middle cerebral artery (MCA). However, there is the possibility of utilizing both branches of the STA when performing the bypass, characterizing the double-barrel (DB) STA-MCA bypass. Notably, a lack of studies evaluating this technique led the authors to conduct a systematic review and single-arm meta-analysis. METHODS: PubMed, Embase and Web of Science were searched systematically for publications of DB-STA-MCA bypass on November 1st, 2023. The findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Case reports were not included for statistical analysis purposes. RESULTS: The review included 408 patients and 534 bypasses from 34 studies. The main etiology was Moyamoya disease (64.6%), followed by cerebral ischemia (22.2%) and aneurysms (12.5%). The median of the mean follow-ups of each study was 12.8 months (range 1.5-87.9). The postoperative patency was 100%. The follow-up patency was 98% (95% CI: 96%-100%; I2 = 0%). The procedure-related mortality was 0% (95% CI: 0%-1%; I2 = 0%). Aneurysms obtained 87% (95% CI: 72%-100%; I2 = 4%) of good clinical outcomes, while Moyamoya disease yielded a rate of 70% (95% CI: 10%-100%; I2 = 97%). Ischemic complications occurred at a rate of 6% (95% CI: 2%-11%; I2 = 36%), while hemorrhagic occurred at 6% (95% CI: 1%-11%; I2 = 56%). Hyperperfusion syndrome rate was calculated as 18% (7%-30%; I2 = 55%) for Moyamoya disease. CONCLUSIONS: The procedure appears to be safe, with excellent patency rates. The clinical efficacy for ischemic and Moyamoya diseases warrants further standardized robust investigation with a broader number of patients, and aneurysm studies are required to enhance sample sizes. The main complication for the Moyamoya subgroup is hyperperfusion syndrome.
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Revascularización Cerebral , Arteria Cerebral Media , Arterias Temporales , Humanos , Revascularización Cerebral/métodos , Arteria Cerebral Media/cirugía , Arterias Temporales/cirugía , Resultado del Tratamiento , Aneurisma Intracraneal/cirugía , Enfermedad de Moyamoya/cirugía , Isquemia EncefálicaAsunto(s)
Revascularización Cerebral , Circulación Colateral , Angiografía por Resonancia Magnética , Enfermedad de Moyamoya , Humanos , Enfermedad de Moyamoya/cirugía , Enfermedad de Moyamoya/diagnóstico por imagen , Revascularización Cerebral/métodos , Circulación Colateral/fisiología , Circulación Cerebrovascular/fisiología , Femenino , Masculino , Piamadre/irrigación sanguínea , Piamadre/diagnóstico por imagen , Piamadre/cirugía , AdultoAsunto(s)
Revascularización Cerebral , Circulación Colateral , Angiografía por Resonancia Magnética , Enfermedad de Moyamoya , Enfermedad de Moyamoya/cirugía , Enfermedad de Moyamoya/diagnóstico por imagen , Humanos , Revascularización Cerebral/métodos , Circulación Colateral/fisiología , Circulación Cerebrovascular/fisiología , Piamadre/irrigación sanguínea , Piamadre/diagnóstico por imagen , Piamadre/cirugíaRESUMEN
BACKGROUND: To investigate the association between BMI and the incidence of ischemic stroke in patients with symptomatic artery occlusion, and further to evaluate the utility of BMI as a screening tool for identifying candidates for extracranial-intracranial bypass surgery. MATERIALS AND METHODS: The authors analyzed the relationship between BMI and the occurrence of ipsilateral ischemic stroke (IIS) among patients receiving only medical management in the Carotid or Middle cerebral artery Occlusion Surgery Study (CMOSS). Additionally, the authors compared the primary endpoint of CMOSS-stroke or death within 30 days, or IIS after 30 days up to 2 years-among patients with varying BMIs who underwent either surgery or medical treatment. RESULTS: Of the 165 patients who treated medically only, 16 (9.7%) suffered an IIS within 2 years. BMI was independently associated with the incidence of IIS (hazard ratio: 1.16 per kg/m 2 ; 95% CI: 1.06-1.27). The optimal BMI cutoff for predicting IIS was 24.5 kg/m 2 . Patients with BMI ≥24.5 kg/m 2 experienced a higher incidence of IIS compared to those with BMI <24.5 kg/m 2 (17.4 vs. 0.0%, P <0.01). The incidence of the CMOSS primary endpoint was significantly different between the surgical and medical groups for patients with BMI ≥24.5 kg/m 2 (5.3 vs. 19.8%, P <0.01) and those with BMI <24.5 kg/m 2 (10.6 vs. 1.4%; P =0.02). Surgical intervention was independently associated with a reduced rate of the CMOSS primary endpoint in patients with BMI ≥24.5 kg/m 2 . CONCLUSION: Data from the CMOSS trial indicate that patients with BMI ≥24.5 kg/m 2 are at a higher risk of IIS when treated medically only and appear to derive greater benefit from bypass surgery compared to those with lower BMIs. Given the small sample size and the inherent limitations of retrospective analyses, further large-scale, prospective studies are necessary to confirm these findings.