A Long-term Clinical Outcome Analysis In Moyamoya Disease Patients After Different Bypass Surgical Modalities

ObjectiveBypass surgery is the most common treatment for moyamoya disease all over the world which including indirect,direct and combined revascularization,but the best surgical modalities are still controversies.The aim of this study was to assess the clinical outcome of moyamoya patients after undergoing different bypass surgeries and discuss the optimal surgical modality for moyamoya disease.MethodsWe retrospectively collected 132 consecutive moyamoya disease patients treated in the Second Affiliated Hospital of Medical School,Zhejiang university from Jan.1,2013 to Dec.31,2016.Patients who did not undergo bypass surgeries and incomplete data and those who underwent different surgical procedures in bilateral hemispheres were excluded.Finally,55 MMD patients who were observed in follow-up for at least 1 years were included:40 patients underwent direct or combined surgery and 15 patients underwent indirect bypass.Three indicators of clinical outcome were assessed and compared between DB or CB surgical group and IB surgical group:stroke recurrences,modified Rankin Scale scores and changes in the main symptoms.ResultsAll patients mean follow-up times was 30 months.During the follow-up period,4 cases were lost to follow-up,recurrent stroke events occurred in 9 patients,including 5 patients with ischemia(transient ischemic attack in 4 patients and infraction in 1 patient)and 4 patients with hemorrhage.The Kaplan-Meier analysis showed that patients who underwent CB or DB had a longer stroke-free time(P=0.01)for all patients and longer ischemia-free time(P=0.029)for ischemic MMD patients than those who underwent IB surgery.On the contrary,there was no significant difference in the hemorrhage-free time between different surgical approaches for hemorrhagic MMD patients(P=0.46).In addition,surgical modalities were not significantly associated with outcome neurological status(P=0.679)and the degree of symptoms improvement(P=0.502).ConclusionsCB or DB and IB have no significant effects on long-term clinical outcome for MMD,but CB and DB are superior in preventing recurrent ischemic stroke events.However,there is no evidence that CB and DB are more effective in preventing re-bleeding.