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Moyamoya angiopathy: early postoperative course within 3 months after STA–MCA–bypass surgery in Europe—a retrospective analysis of 64 procedures

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Abstract

Background

Despite the consensus on the necessity of revascularizing surgery in Moyamoya angiopathy in Asia, the indication in Caucasian Moyamoya patients is discussed controversially.

Objective

The safety of revascularizing surgery in Europe should be clarified.

Methods

This study retrospectively analyzed the rate of complications as well as clinical symptoms within the first 3 months after bypass surgery between superficial temporal artery and middle cerebral artery (STA–MCA).

Results

64 direct bypass procedures in 45 patients (95.5% Caucasians) were analyzed. The magnetic resonance imaging at day 6 showed subdural hematoma in 60.3%. The mean diameter of these hematomas on magnetic resonance imaging was 5.1 mm (SD 3.4 mm) and increased in 25% at follow-up. No difference was found between those patients with early (day 1) or late (day 7) restarts of antiplatelet therapy. Magnetic resonance imaging at day 6 revealed hyperperfusion syndrome after six of 64 procedures (9.3%). Three of these six had clinical symptoms; two-thirds were transient within seconds. Magnetic resonance imaging depicted stroke after seven procedures (10.9%). Five of these seven patients had no new symptoms. Altogether, after ten procedures (15%), patients complained about clinical symptoms. These were all transient. No new transient ischemic attacks occurred during the 3 month follow-up and no new lesions were detected in magnetic resonance imaging. Only two patients underwent surgery for asymptomatic subdural hematoma. All other subdural hematomas resolved spontaneously.

Conclusion

Revasculating surgery is a safe procedure in Caucasian patients with Moyamoya angiopathy. The observed complications have a good prognosis.

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Funding

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Authors and Affiliations

  1. Department of Neurology, Alfried Krupp Hospital, Alfried-Krupp-Strasse 21, 45130, Essen, Germany

    Markus Kraemer, Rusen Karakaya, Jan Claudius Schwitalla, Rolf R. Diehl & Peter Berlit

  2. Department of Neurosurgery, Alfried Krupp Hospital, Alfried-Krupp-Strasse 21, 45130, Essen, Germany

    Jasmin Sassen, Rudolf Laumer & Frank Diesner

  3. Department of General Zoology and Neurobiology, University of Bochum, Universitätsstrasse 150, 44780, Bochum, Germany

    Jan Claudius Schwitalla

  4. Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany

    Markus Kraemer, Jonas Graf, Philipp Albrecht & Hans-Peter Hartung

Authors
  1. Markus Kraemer
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  2. Jasmin Sassen
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  3. Rusen Karakaya
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  4. Jan Claudius Schwitalla
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  6. Philipp Albrecht
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  9. Peter Berlit
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  10. Rudolf Laumer
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  11. Frank Diesner
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Corresponding author

Correspondence to Markus Kraemer.

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The authors declare that they have no conflict of interest.

Ethical standards

This study was approved by local ethics-committee.

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Kraemer, M., Sassen, J., Karakaya, R. et al. Moyamoya angiopathy: early postoperative course within 3 months after STA–MCA–bypass surgery in Europe—a retrospective analysis of 64 procedures. J Neurol 265, 2370–2378 (2018). https://doi.org/10.1007/s00415-018-8997-2

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  • DOI: https://doi.org/10.1007/s00415-018-8997-2

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