The Surgical Revascularization On The Adult Patients With Moyamoya Disease And To Establish Experimental Animals Models Of Moyamoya Disease

Objective: To research and compare the clinical effect of direct,indirect and combined revascularization for the treatment of the adult patients with moyamoya disease.Attempt to construct animal model of moyamoya disease through the method of immunity(local injection of xenogeneic serum).Methods:(1)Collecting clinical datas of the adults patients with MMD who underwent surgical revascularization from January 2013 to January 2016 at the authors’ hospital.All patients were followed up by the clinic reexamination,telephones.To observe changes of the patient’s clinical symptoms,imaging changes and abnormal cerebrovascular events.And to evaluate clinical efficacy of the surgery with the patients’ modified Rankin Scale score,imaging changes and the incidence of cerebrovascular events.(2)Using New Zealand white rabbits as the research object,the animal model of moyamoya disease is established by the method of immune induction(local injection of xenogeneic serum).The rabbits are randomly divided into experimental group and control group.The experimental group is induced by horse serum,while the control group was 0.9% normal saline.The dose of injection amount is 1ml per time,and 1 times a week.The experimental group and the control group are consistent on induced dose,frequency,location.Using CTA and MRA to research the normal rabbit carotid artery system,and respectively review CTA or MRA at 1 months,3 months,6 months after intervening.At the end of the experiment,the rabbits will be killed by air embolism,and the pathological changes of the carotid artery were performed.Results:(1)The clinical datas of 112 patients with MMD were collected,49 patients underwent direct revascularization,41 patients underwent indirect revascularization,22 cases underwent combined revascularization.There were significant differences in the result of mRS of the preoperative and the postoperative with statistical meanings(wilcoxon signed-rank test,P<0.05,CI:95%).The postoperative clinical symptom remission rate of direct and combined surgery is better than that of indirect,but there was no statistically significant difference(chi-square test,χ2 totality=1.146,Ptotality=0.564>0.05).The results of Kaplan-Meier survival analysis showed that the incidence of cerebrovascular events decreased with the prolongation of postoperative follow-up time,there were no significant differences in the incidence of cerebrovascular events among various surgical procedures with statistical meanings(Mantel-Cox test,P=0.677>0.05,CI:95%).(2)There was no obvious stenosis of carotid artery in experimental group.The base of skull found no abnormal vascular network.And the pathological results showed that there was no obvious inflammatory change in the carotid artery intima of the experimental group compared with the control group.Conclusion:(1)Direct,indirect,and combined revascularization is an effective method for treatment of the adults patients with moyamoya disease.(2)There was no significant difference in the clinical efficacy of direct,indirect and combined revascularization in the treatment of the adults patients with moyamoya disease.(3)Through local injections of heterogeneous serum can not cause the rabbits’ carotid artery to stenosis,and the brain imaging had no change.Whether through the method of local injection of xenogeneic serum to construct animal model of moyamoya disease and inflammation can independently induce moyamoya disease needs further research.