A Retrospective Control Study On The Short-term Efficacy Of Single Anastomosis And Double Anastomosis Of Extracranial And Intracranial Vessels In The Treatment Of Ischemic Moyamoya Disease

Objective: To investigate and analyze the postoperative short-term efficacy of single vessel direct anastomosis combined with temporal muscle graft indirect anastomosis and double vessel direct anastomosis combined with temporal muscle graft indirect anastomosis in the treatment of ischemic type moyamoya disease;Possible risk factors for complications in both groups were analyzed;More references are provided for the choice of better operative methods in clinical empirical treatment.Methods: This paper retrospectively analyzed the data of patients diagnosed with ischemic moyamoya disease admitted to our department from April 2015 to December 2019.Double anastomosis was the first choice for all patients,and single anastomosis(including single superficial temporal artery-middle cerebral artery bridging,posterior auricular artery-middle cerebral artery bridging,etc.)was selected for only one branch of the superficial temporal artery or one of the branches was slender,short in length or even absent from the superficial temporal artery.Preoperative indicators were collected,including mRS score,moyamoya disease stage,the presence of ischemic events within half a year before the surgery,the ischemic sites,the lateral features and the degree of decline of CTP,etc.Three months after the operation,the patient's CTP and DSA were improved and the information of mRS score,pine island grading score and wound healing was collected.Patients were followed up by telephone 6 months after the operation or at the last follow-up,including no onset,TIA,cerebral infarction,cerebral hemorrhage,epilepsy,etc.The main endpoints of postoperative observation were hemorrhagic stroke,ischemic stroke(in patients with frequent large-scale cerebral infarction),and death.Secondary endpoint events were brain hyperperfusion,seizures,wound infection/delayed healing,etc.Statistical analysis was conducted on all counting data by ?~2 test.Correction for continuity and Fisher's exact test method were selected according to the data.Shapiro-wilk normality test was conducted on the measurement data.Result: 1.In the single anastomosis group,3 cases(3/8,37.5%)had mRS score aggravation.In the double anastomosis group,2 cases(2/39,5.13%)presented mRS score aggravation.The difference of aggravation rate was statistically significant(?~2=4.309,P=0.038 < 0.05).2.The main endpoint events of the two groups were calculated.In the single anastomosis group,1 patient(1/8,12.5%)had cerebral infarction,without cerebral hemorrhage and died.In the double anastomosis group,3 patients(3/39,7.69%)had cerebral infarction,no cerebral hemorrhage and no death.The difference between the two groups was not statistically significant(P =1.000 > 0.05).3.Secondary endpoint events of the two groups were calculated.In the single anastomosis group,2 cases(2/8,25%)were hyperperfusion,3 cases(3/8,37.5%)were mRS score aggravation,and there were no epileptic patients.In the double anastomosis group,there were 6 cases(6/39,15.38%)of hyperperfusion,2 cases(2/39,5.13%)of epilepsy,2 cases(2/39,5.13%)of aggravation of mRS score,11 cases(11/39,28.21%)of grade 1,27 cases(27/39,69.23%)of grade 2,and 1 case(1/39,2.56%)of grade 3.Statistical analysis showed that the proportion of mRS aggravation in the single anastomosis group was higher than that in the double anastomosis group(P =0.038 < 0.05),and the postoperative collateral circulation reconstruction in the double anastomosis group was significantly better than that in the single anastomosis group(P =0.005 < 0.05).4.The data of anastomosis vascular patency were calculated.There were 3 cases of vascular occlusion in the single anastomosis group(3/8,37.5%)and 1 case of vascular occlusion in the double anastomosis group(1/39,2.56%),the difference was statistically significant(?~2=6.402,P =0.011 < 0.05).5.The CTP of 25 patients for statistical results,analysis of two groups of patients number of hyperperfusion high-risk areas in the CTP,single anastomosis of 4 cases of 4/5(%),double anastomosis of five,13.16%(5/38),the hyperperfusion of high-risk areas of single anastomosis,with 1 case(1/5),%),double anastomosis of 33 cases of,86.84%(33/38),the results was statistically significant(?~2= 8.232,P = 0.004 < 0.05).Conclusion: 1.Compared with the double anastomosis group,the single anastomosis group had a higher risk of local hyperperfusion and a higher proportion of mRS score aggravation.2.Compared with single anastomosis,the proportion of blood vessel patency of double anastomosis was higher(or the capacity of anastomosis blood vessel reserve was stronger),and the area of brain covered by postoperative vascular reconstruction was higher,which was more conducive to the increase of collateral circulation reserve in patients.3.There was no significant difference in the postoperative primary endpoint events between the two groups,but the difference in secondary endpoint events between the two groups showed that the double anastomosis group was significantly superior to the single-anastomosis group in postoperative neurological function and collateral circulation vascular reconstruction,and the double anastomosis group may bring better long-term efficacy for the patients.