Radial Artery Grafts as Rescue Strategy for Patients with Moyamoya Disease for Whom Conventional Revascularization Failed

World Neurosurgery
Satoshi HoriPeter Vajkoczy

Abstract

Failure of direct revascularization with superficial temporal artery (STA)-middle cerebral artery (MCA) bypass for Moyamoya disease (MMD) is comparatively rare. However, for those cases where a bypass fails to prevent further ischemic attacks, safe and efficient rescue strategies are needed. We present our experience with radial artery grafts for secondary revascularization of MMD. Between April 2007 and April 2014, we have performed STA-MCA bypass in 182 patients diagnosed with Moyamoya vasculopathy. Four patients with typical MMD who had an unsuccessful STA-MCA bypass required additional revascularization because they remained symptomatic. Digital subtraction angiography revealed delayed STA graft failure in these patients, who continued to have transient ischemic attacks after the initial surgery. Cerebral blood flow studies confirmed persistent impairment of cerebrovascular reserve capacity. As an escape strategy, we performed radial artery graft bypass surgery from the external carotid artery to the M2 or M3 portion of the MCA. The median duration between the 2 surgeries was 10 months. The mean follow-up period after rescue revascularization was 8.5 ± 3.3 months. Revascularization with the radial artery graft was successfu...Continue Reading

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Citations

Jan 19, 2018·Stroke; a Journal of Cerebral Circulation·Güliz AckerPeter Vajkoczy
May 23, 2020·Operative Neurosurgery·Kristine Ravina, Jonathan J Russin
Jan 20, 2018·Operative Neurosurgery·Jonathan Russin, Joseph Carey
Jul 17, 2021·Frontiers in Neurology·Kristin LuciaPeter Vajkoczy
Sep 17, 2021·Translational Stroke Research·R MertensP Vajkoczy

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