title: Indirect Revascularization for Non-Moyamoya Disease Anterior Circulation Arterial Steno-occlusion: Clinical Features, Surgical Treatment, and Medium-Term Outcomes in Adults.
abstract: BACKGROUND
  Symptomatic anterior arterial steno-occlusion is often associated with neurofunctional deficits or a high risk of recurrent stroke or both. Although both medical and endovascular treatments are useful and suitable, few studies have investigated the continued use of indirect encephaloduroarteriosynangiosis (EDAS) bypass in patients with non-moyamoya disease ischemia. We retrospectively investigated clinical features, surgical treatments, and medium-term outcomes of indirect revascularization for patients with non-moyamoya disease anterior circulation arterial steno-occlusion in China.
  
  
  METHODS
  EDAS without burr holes was performed in 51 adult patients with cerebral ischemic events and diagnosed nonmoyamoya anterior circulation arterial steno-occlusion. Preoperative, postoperative, and follow-up neurologic status was evaluated using the National Institutes of Health Stroke Scale; changes on angiography and perfusion-weighted magnetic resonance imaging were evaluated.
  
  
  RESULTS
  Unilateral EDAS was performed in 48 patients, and bilateral EDAS was performed in 3 patients. Four patients experienced complications before hospital discharge; only 23 patients underwent follow-up angiograms. Of the 51 patients, 44 (86.3%) exhibited improved muscle strength; 21 of 23 patients (91.3%) with follow-up angiography data exhibited evidence of new visible branches from the superficial temporal artery or middle meningeal artery or both. Preoperative and postoperative perfusion-weighted magnetic resonance imaging was performed for 5 patients. Despite clinical improvement in all patients, only 2 exhibited hemodynamic improvement.
  
  
  CONCLUSIONS
  Indirect revascularization may be safe and effective for improving blood flow to the ischemic region following nonmoyamoya anterior circulation arterial steno-occlusion, especially in patients with residual postinfarction neurologic deficits. Our study demonstrates that improvements in ischemic symptoms after EDAS correspond to neovascularization from the superficial temporal artery or middle meningeal artery in ischemic brain areas.
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Huaiyu
authors.initials: H
authors.lastname: Tong
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Yudong
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China; Department of Neurosurgery Liaocheng People's Hospital, 67 Dongchang Road, Liaocheng City, Shandong 252000, China.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Zhiqi
authors.initials: Z
authors.lastname: Mao
authors.affiliation: Department of Neurosurgery, Chinese 252 Hospital, Hebei, China.
authors.forename: Baojun
authors.initials: B
authors.lastname: Yao
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Aijia
authors.initials: A
authors.lastname: Shang
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Ruozhuo
authors.initials: R
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China. Electronic address: xinguang_yu@263.net.
authors.forename: Xinguang
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China. Electronic address: zhoudingbiao301@163.com.
authors.forename: Dingbiao
authors.initials: D
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D001921:Brain / Q000000981:diagnostic imaging / Q000601:surgery; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D002681:China; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anterior circulation; Cerebral arterial occlusion; Cerebral arterial stenosis; Encephaloduroarteriosynangiosis; Indirect revascularization