Long-term clinical and radiological outcomes of extracranial-intracranial bypass in hemorrhagic patients with Moyamoya disease: A single-center observational study of 45 cases.

OBJECTIVE

The long-term effect of superficial temporal artery-middle cerebral artery (STA-MCA) bypass and corresponding hemodynamics in hemorrhagic moyamoya disease (MMD) remained unclear. This study aimed to investigate the incidence of long-term rebleeding events, bypass patency, neovascularization, and changes in hemispheric prefusion in hemorrhagic MMD patients.

METHODS

Clinical and radiographic images for 35 hemorrhagic MMD patients (45 hemispheres) using STA-MCA bypass were recorded. The patients' demographic information, clinical presentation, associated medical conditions, hemispheric perfusion status, and clinical course were obtained from reviewing medical records, cerebral angiography, and CT perfusion (CTP) during long-term follow-up.

RESULTS

Of the 45 cases with an average follow-up of 38 months, 7 cases (15.5%, 2.08% per year) experienced new cerebral hemorrhages. The latest cerebral angiography indicated patent bypass in 32 cases (71.1%) and Matsushima grade A in 16 cases (35.6%). Distribution analysis of modified Suzuki stages and moyamoya vessels patterns showed significant changes (P < 0.05), with a higher proportion of patients progressing to advanced stages and a decrease in moyamoya vessels. There was a significant improvement in neurological outcomes (P = 0.004), with 80.0% of cases achieving normal neurological function. Long-term CTP analysis revealed no significant differences in rCBF compared to preoperative values (P > 0.05). However, rCBV significantly decreased in the caudate nucleus, parietal lobe, and striatum (P < 0.05). Significant decrease in rMTT and rTmax parameters were noted in several regions, including the genu of the corpus callosum, caudate nucleus, dorsal thalamus, and multiple cortical regions, indicating a reduction in microcirculation time (P < 0.05).

CONCLUSION

STA-MCA bypass could improve long-term neurological outcomes in hemorrhagic MMD patients, facilitating advancements in Suzuki stages and reducing moyamoya vessels. Long-term CTP results indicated a slight decrease in rCBF in several areas and shortened microcirculation time.

CLINICAL TRIAL NUMBER: Not applicable.