[Comparison of one-stage direct revascularization and medicine therapy for treatment of ischemic moyamoya disease].
OBJECTIVE
To compare the therapeutic effect of one-stage direct revascularization and medicine therapy for the treatment of ischemic moyamoya disease.


METHODS
From March 2002 to March 2008, 18 patients with ischemic moyamoya disease (12 males and 6 females) were treated, aged 9 to 33 years old. Eighteen patients presented with ischemic stroke, including 11 cases of cerebral infarction and 7 cases of transient ischemic attack. According to Chinese ischemic cardiovascular diseases evaluation tools, 17 patients were classified as low risk ischemic stroke and 1 as moderate risk ischemic stroke. Different levels of occlusion branch of the intracranial carotid arteries and pathosis collaterals were identified by DSA. Fourteen patients and 4 patients were showed unilateral and bilateral hypoperfusion of cerebral blood flow by single photon emission computed tomography, respectively. Eleven patients received superficial temporal artery-middle cerebral artery anastomosis and 7 patients received medicine (anti-PLT agglutinin and calcium channel blocker).


RESULTS
All incisions healed at stage I. There was no stroke events during perioperation. Anastomosis vessel vasospasm occurred in 2 patients 5 days after operation; and hyperperfusion syndrome in 1 patient 2 weeks after operation. All patients were followed up 13-32 months (mean 18 months). In 11 anastomosis patients, 6 underwent 6 stroke events within 12 months; in 7 medicine patients, 6 underwent 11 stroke events within 12 months; and showing a significant difference (P < 0.05). The stroke recurrence rate was 85.7% in medicine patients and 54.5% in anastomosis patients 12 months after therapy. DSA showed pathosis collaterals in 7 anastomosis patients and 6 medicine patients 6 months after therapy. After 12 months according to modified Rankin scale, the scores of anastomosis patients were 3 points in 1 case, 2 points in 6 cases and 0-1 point in 4 cases, and the scores of medicine patients were 2 points in 2 cases and 0-1 point in 5 cases; showing no significant difference (P > 0.05).


CONCLUSIONS
As long as onset of stroke occurred and ischemic moyamoya disease is diagnosed, one-stage direct revascularization should be performed, which can reduce the rate of stroke recurrence risk and slow down the progression of disease.
Zhao
Hexiang
H
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu Sichuan, PR China.
You
Chao
C
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002548:Cerebral Revascularization / Q000379:methods; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D020768:Middle Cerebral Artery / Q000601:surgery; D009072:Moyamoya Disease / Q000188:drug therapy* / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D013699:Temporal Arteries / Q000601:surgery; D014656:Vascular Surgical Procedures; D055815:Young Adult
D002121:Calcium Channel Blockers; D010975:Platelet Aggregation Inhibitors