Multiterritorial tailored revascularization in adult Moyamoya patients: expanding revascularization approaches to ACA and PCA territories
Abstract
Extracranial-intracranial (EC-IC) bypass surgery within the middle cerebral artery (MCA) territory is the gold standard for treating Moyamoya patients once hemodynamic insufficiency is confirmed. Although the anterior (ACA) and posterior cerebral arteries (PCA) are frequently involved, revascularization of these territories is not yet part of the standard treatment regimen; most centers focus exclusively on the MCA. Our approach, however, targets all hemodynamically compromised regions by providing tailored, multi-territorial revascularizations. Indications for additional ACA and/or PCA bypasses are determined by advanced imaging, such as PET-CT or CO2-triggered breath-hold MRI (bh-fMRI), to precisely evaluate cerebrovascular reserve. Here, we present the results of the first large case series focusing on non-MCA revascularization in adult Moyamoya patients. A total of 233 Moyamoya patients were analyzed, of whom 66 (28.3%) underwent 124 non-MCA revascularization procedures. These targeted the ACA (n = 113) and the PCA territories (n = 11). For the ACA, revascularization was predominantly indirect (n = 111 procedures; 98%), with only two direct bypasses (2%). In contrast, PCA revascularization was was more evenly distributed between direct (n = 6, 55%) and indirect (n = 5, 45%) procedures. At the 12-month follow-up, graft patency for direct bypasses and robust collateral development for indirect bypasses were observed in 100% and 93.7% of procedures, respectively. Among the…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 233 participants or records.
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