Clinical and CT perfusion outcomes after direct STA-MCA bypass in moyamoya and non-moyamoya steno-occlusive disease: an Indonesian single-center cohort.

BACKGROUND

Direct superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass is used for selected haemodynamic cerebrovascular disorders, but comparative data between moyamoya and non-moyamoya disease remain limited in Indonesia.

METHODS

Consecutive patients undergoing direct STA-MCA bypass from 2021 to 2025 were retrospectively analysed. Clinical and operative outcomes were assessed in 68 patients; paired CT perfusion data were available in 41.

RESULTS

The cohort included 40 patients with moyamoya disease and 28 with non-moyamoya disease, predominantly intracranial atherosclerotic disease [27/28 (96%)]. Patients with moyamoya were younger [41 (29-49) vs 48 (38-59) years; p = 0.003] and had lower rates of diabetes mellitus [7% vs 29%; p = 0.041] and hypertension [42% vs 86%; p < 0.001]. Bypass patency was documented in 90% versus 100% (p = 0.226). Paired modified Rankin Scale scores improved in both cohorts: from 2.08 ± 1.51 to 1.38 ± 1.39 in moyamoya (mean difference 0.70; p < 0.001) and from 2.82 ± 1.19 to 1.86 ± 1.33 in non-moyamoya disease (mean difference 0.96; p < 0.001). M4 frontal clipping time was longer in moyamoya [33 (31-37) vs 26 (24-32) minutes; p = 0.002]. Postoperative seizure occurred in 15% versus 7% (p = 0.455), and ischaemic stroke in 0% versus 11% (p = 0.065). In the CT perfusion cohort, pre-bypass Tmax was higher in non-moyamoya disease [2.17 (1.25-3.34) vs 1.31 (1.10-1.92); p = 0.048], while infarct volume was higher in moyamoya [8.65 (1.41-17.23) vs 5.63 (3.35-7.32) mL; p = 0.034]. No follow-up CT perfusion parameter differed significantly.

CONCLUSION

Direct STA-MCA bypass was followed by functional improvement in both cohorts and comparable follow-up CT perfusion profiles.