title: Surgical outcomes following encephaloduroarteriosynangiosis in adult moyamoya disease associated with Type 2 diabetes.
abstract: OBJECTIVE Debate exists regarding the merits and shortcomings of an indirect bypass procedure for treating adult patients with moyamoya disease (MMD). Considerable variation in neovascularization occurs among different organs in patients with diabetes mellitus. Here, the effect of encephaloduroarteriosynangiosis on MMD associated with Type 2 diabetes mellitus (T2DM) is evaluated. METHODS A retrospective and 1:2 matched case-control study was conducted in moyamoya patients with or without T2DM (n = 180). Postoperative collateral formations were graded according to the Modified Collateral Grading System that originated from the Matsushima Angiographic Stage Classification. Neurological function outcomes before and after the operation were evaluated according to the modified Rankin Scale. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for clinical outcome. RESULTS There was no statistically significant difference in the constituent ratios of initial symptom and preoperative Suzuki stage between patients with and without T2DM. Progression of angiopathy around the circle of Willis was postoperatively observed in bilateral internal carotid arteries in both groups. Patients with T2DM had a higher postoperative Suzuki stage (p < 0.01) and more frequent development of collateral angiogenesis germinating from the external carotid after indirect revascularization procedures in the surgical cerebral hemisphere (82.7% vs 72.2%; p < 0.05). The extent of postoperative collateral formation in patients with diabetes mellitus was significantly higher (p < 0.01). Postoperative clinical improvement in the diabetes group was more common after revascularization procedures (p < 0.05), and the diabetes group had lower modified Rankin Scale scores (p < 0.05) in comparison with the nondiabetes group. Late postoperative stroke and posterior cerebral artery involvement were identified as predictors of unfavorable clinical outcome in both groups, while T2DM was associated with a favorable clinical outcome. CONCLUSIONS Encephaloduroarteriosynangiosis is an efficacious treatment for adult patients with MMD. Patients with T2DM could achieve better collateral circulation and clinical improvement following surgery.
authors.affiliation: Cardiovascular Drug Research Center, Institute of Health and Environmental Medicine, Academy of Military Medical Sciences; and.|Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and.
authors.forename: Bin
authors.initials: B
authors.lastname: Ren
authors.affiliation: Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and.
authors.forename: Zheng-Shan
authors.initials: ZS
authors.lastname: Zhang
authors.affiliation: Consulting Centre of Biomedical Statistics, Academy of Military Medical Sciences, Beijing, China.
authors.forename: Wei-Wei
authors.initials: WW
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and.
authors.forename: Xiang-Yang
authors.initials: XY
authors.lastname: Bao
authors.affiliation: Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and.
authors.forename: De-Sheng
authors.initials: DS
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and.
authors.forename: Cong
authors.initials: C
authors.lastname: Han
authors.affiliation: Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and.
authors.forename: Peng
authors.initials: P
authors.lastname: Xian
authors.affiliation: Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and.
authors.forename: Feng
authors.initials: F
authors.lastname: Zhao
authors.affiliation: Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.affiliation: Cardiovascular Drug Research Center, Institute of Health and Environmental Medicine, Academy of Military Medical Sciences; and.
authors.forename: Hai
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular Disease; and.
authors.forename: Lian
authors.initials: L
authors.lastname: Duan
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002548:Cerebral Revascularization / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D009072:Moyamoya Disease / Q000150:complications* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods
keywords: CBF = cerebral blood flow; DM = diabetes mellitus; EDAS = encephaloduroarteriosynangiosis; MCA = middle cerebral artery; MMD = moyamoya disease; PCA = posterior cerebral artery; STA = superficial temporal artery; T2DM = Type 2 DM; Type 2 diabetes; clinical outcome; collaterals; mRS = modified Rankin Scale; moyamoya disease; revascularization; vascular disorders