A Prospective Study on Hemodynamics of Combined Bypass Surgery in the Treatment of Moyamoya Disease.

OBJECTIVE

The study investigates the clinical effectiveness and prognosis of selecting recipient vessels for moyamoya disease (MMD) treatment during combined bypass surgery, focusing on hemodynamic criteria.

METHODS

Ninety-six MMD patients were randomly assigned to 3 groups (A, B, C) of 32 each, undergoing combined bypass surgery. Group A selected the vessel with the fastest fluorescing in the surgical field, group B the slowest, and group C used traditional methods. The authors monitored intraoperative recipient vessel pressure, cerebral blood flow (CBF), and modified Rankin scale (mRS) scores pre-surgery and post-surgery, and compared clinical symptom improvement, stroke recurrence, CBF, and mRS during a 6-month follow-up.

RESULTS

Postoperatively, groups A and B had significantly higher recipient vessel pressures than group C, with group B showing the highest ( P <0.05). CBF increased significantly in all groups at 7 days post-surgery and at 6 months, with groups A and B outperforming C, and group B showing the highest increase at 7 days ( P <0.05). mRS scores decreased significantly, with groups A and B showing lower scores than C at 6 months ( P <0.05). However, group B had a higher incidence of clinical symptoms post-surgery compared with A and C ( P <0.05).

CONCLUSION

The study demonstrates that hemodynamic-based recipient vessel selection significantly improves clinical outcomes in MMD patients undergoing combined bypass surgery. Although group B showed the best hemodynamic results, it also had a higher incidence of immediate postoperative symptoms, suggesting a need for a balanced approach to optimize both short-term and long-term patient outcomes.