Indirect Revascularization Combined With Bone Marrow Stem Cell Mobilization And Simvastatin For The Treatment Of Moyamoya Disease

ObjectiveTo assess the safety and efficacy of combination therapy of autologous bone marrow stem cells (BMSCs) and simvastatin for moyamoya disease.Methods59 patients with moyamoya disease were enrolled and analyzed retrospectively (23 male,36 female, patient age,7-49). They were assigned into 2 groups according to the treatment:A group (Encephalo-duro-arterio-myo-synangiosis treatment as control), B group (BMSCs mobilization+ simvastatin+indirect revascularization treatment). Patient received daily subcutaneous injection of granulocyte-colony stimulating factor (G-CSF)/Granulocyte macrophage colony-stimulating factor (GM-CSF) 7 days after TBI for 21 days. Patient received simvastatin orally in dose of 10mg/d 3 day after the surgery. The patients underwent preoperative and follow-up neurological assessment using the Barthel Index (BI), the Chinese Stroke volume Table (CSS) and National Institute of Health stroke scale score (NIHSS score). Peripheral blood CD133+CD34+ cells were analyzed with flow cytometer.Results1. The Barthel index (BI):There was no statistical difference before the treatment (P>0.05). Barthel index gradually improved 1m,3m,6m after the surgery. Barthel index in group B were higher compared with group A at different time points (P<0.05).2. Neurological deficit scores:There was no statistical difference before the treatment (P>0.05). Neurological deficit scores gradually decreased 6m,12m after the surgery. There was significant difference between combination therapy groups and surgery-alone treated groups 6m and 12m after the surgery (P<0.05).3. The Chinese Stroke volume Table (CSS):After the treatment, CSS decreased both in group A and B. The results of group B were significantly lower compared with group A (P<0.05). 4. The CD133+CD34+ cells:There was no statistical difference between the two groups before the treatment (P>0.05). The CD133+CD34+ cells in group A and B were significantly higher 3w after the surgery (P<0.05). The number of CD133+CD34+ cells in group B were more than group A 3w after TBI, and had a statistical difference (P<0.05).No patients experienced serious complications during the treatment.Conclusion1. Encephalo-duro-arterio-myo-synangiosis (EDAMS) demonstrated effective cortical revascularization through temporal muscle, dura mater and surperficial temporal artery, effectively improves the cerebral blood circulation.2. Combination Therapy of bone marrow stem cell mobilization and simvastatin could mobilize the autologous BMSCs to participate in neuronal regeneration and neovascularization, and promote remodeling of cerebral tissue.3. Indirect revascularization combined with bone marrow stem cell mobilization and simvastatin could enhance functional recovery in moyamoya patients.