Rescue direct bypass after insufficient prior revascularization in moyamoya disease: Feasibility of using reused or preserved superficial temporal artery branches.

OBJECTIVES

To describe the feasibility and short- to mid-term outcomes of rescue direct or combined revascularization using reused or preserved superficial temporal artery branches in patients with moyamoya disease after insufficient prior revascularization.

METHODS

We retrospectively reviewed five patients with moyamoya disease who underwent repeat revascularization for recurrent ischemic or hemorrhagic stroke after prior revascularization. Donor suitability was assessed using digital subtraction angiography to determine whether the previous donor artery had developed effective collateralization and SPECT to identify persistent hemodynamic compromise.

RESULTS

Three patients underwent rescue direct bypass using a previously used STA branch that had failed to develop sufficient collateralization. Two patients underwent rescue revascularization using an STA branch that had not been used during the initial operation. All patients underwent successful rescue direct or combined revascularization. Bypass patency was confirmed intraoperatively and postoperatively in all cases. No postoperative ischemic or hemorrhagic complications occurred, and no patient experienced recurrent stroke during follow-up.

CONCLUSIONS

Rescue direct or combined bypass using reused or preserved STA branches may be feasible in carefully selected patients with recurrent stroke after prior revascularization. Preoperative angiographic confirmation of donor suitability and perfusion imaging are essential for selecting the appropriate rescue strategy.