Yu Jin, Du Qian, Hu Miao, Tao Tianshu, Wan Guiping, Zhang Jianjian, Chen Jincao
Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, China.
Wuhan Asia General hospital, Wuhan, 430071, China.
Sci Rep. 2024 Dec 2;14(1):29961. doi: 10.1038/s41598-024-81362-6.
In our recent study, we introduced a novel side-to-side (S-S) bypass technique for adult moyamoya disease (MMD) patients. We aimed to validate the potential of this technique in enhancing postoperative revascularization. Patients undergoing S-S or end-to-side (E-S) bypass were enrolled, clinical data and angiography parameters were collected and compared. We included 44 E-S and 40 S-S MMD patients. There were no significant differences in basic characteristics and postoperative Matsushima grades between the two groups. However, in the S-S group, fewer patients had Matsushima grade D (0%) compared to the E-S group (11.4%, P = 0.028). The S-S group showed a greater occipital artery (OA) participation in revascularization (87.5% vs. 56.8%, P = 0.002) and higher postoperative caliber change ratio (CCR) of the superficial temporal artery (STA)-frontal branch (1.26 ± 0.43 vs. 1.04 ± 0.53, P = 0.038) compared to the E-S group. This difference was more pronounced in the subgroup with poor revascularization outcomes: in the S-S group, the CCR of the STA-frontal branch and the degree of participation in revascularization were 1.163 ± 0.168 and 58.8%, respectively, while in the E-S group, they were only 0.798 ± 0.494 and 6.7%. The S-S group also had a higher OA CCR (1.133 ± 0.257) and participation (82.4%) compared to the E-S group (0.941 ± 0.216 and 37.5%, respectively). In conclusion, the S-S bypass technique effectively utilizes scalp arteries, particularly the STA-frontal branch and OA, for direct revascularization via the preserved distal STA in adult MMD patients. Scalp arteries can serve as a supplementary source of donor arteries, especially beneficial for patients with suboptimal revascularization outcomes.
在我们最近的研究中，我们为成年烟雾病（MMD）患者引入了一种新型的侧 - 侧（S - S）搭桥技术。我们旨在验证该技术在增强术后血管重建方面的潜力。纳入接受S - S或端 - 侧（E - S）搭桥的患者，收集并比较临床数据和血管造影参数。我们纳入了44例接受E - S搭桥和40例接受S - S搭桥的MMD患者。两组患者的基本特征和术后松岛分级无显著差异。然而，与E - S组（11.4%，P = 0.028）相比，S - S组中松岛分级为D级的患者较少（0%）。与E - S组相比，S - S组枕动脉（OA）参与血管重建的比例更高（87.5%对56.8%，P = 0.002），颞浅动脉（STA） - 额支的术后管径变化率（CCR）也更高（1.26±0.43对1.04±0.53，P = 0.038）。这种差异在血管重建效果不佳的亚组中更为明显：在S - S组中，STA - 额支的CCR和血管重建参与度分别为1.163±0.168和58.8%，而在E - S组中，它们分别仅为0.798±0.494和6.7%。与E - S组（分别为0.941±0.216和37.5%）相比，S - S组的OA CCR（1.133±0.257）和参与度（82.4%）也更高。总之，S - S搭桥技术有效地利用头皮动脉，特别是STA - 额支和OA，通过保留的远端STA为成年MMD患者进行直接血管重建。头皮动脉可作为供体动脉的补充来源，尤其有利于血管重建效果欠佳的患者。
