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Effects of aspirin and heparin treatment on perioperative outcomes in patients with Moyamoya disease

  • Original Article - Vascular Neurosurgery - Other
  • Published:
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Abstract

Background

When superficial temporal artery-middle cerebral artery bypass is combined with indirect methods (e.g., revascularization surgery) to treat Moyamoya disease (MMD), antiplatelet treatment can impact bypass patency, infarction, or hemorrhage complications. Recently, heparin has been proposed as an anticoagulant treatment against white thrombus at the anastomosis site. The study aims to evaluate the effect of aspirin on the perioperative outcomes and investigate the results of heparin treatment for white thrombus.

Methods

This retrospective study included 74 procedures of combined revascularization surgery for MMD patients who either received or did not receive aspirin. Perioperative outcomes were compared between the two groups. In addition, the effects of heparin treatment for white thrombus were evaluated.

Results

The rate of white thrombus at the anastomosis site was significantly higher in the non-aspirin medication group (univariate: p = 0.032, multivariate: p = 0.044) and, accordingly, initial bypass patency was lower in the non-aspirin medication group (p = 0.049). Of the 17 patients with white thrombus development, five received heparin injections, and all white thrombi disappeared; however, there was one case of epidural hematoma and another of subdural hematoma. The risk of hemorrhagic complications was significantly higher in the surgical procedures that received heparin injections (p = 0.021).

Conclusions

In MMD patients who received combined revascularization surgery, aspirin medication lowered the occurrence of white thrombus. Heparin injections help to treat white thrombus but can enhance the risk of hemorrhagic complications.

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Abbreviations

CT:

Computed tomography

ICH:

Intracranial hemorrhage

MCA:

Middle cerebral artery

MMD:

Moyamoya disease

MRA:

Magnetic resonance angiography

MRI:

Magnetic resonance imaging

PCA:

Posterior cerebral artery

SD:

Standard deviation

STA:

Superficial temporal artery

TIA:

Transient ischemic attack

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Authors and Affiliations

  1. Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan

    Fumiaki Kanamori, Yoshio Araki, Kinya Yokoyama, Kenji Uda, Takashi Mamiya, Masahiro Nishihori, Takashi Izumi & Atsushi Natsume

  2. Aichi Rehabilitation Hospital, Nishio, Japan

    Sho Okamoto

Authors
  1. Fumiaki Kanamori
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  2. Yoshio Araki
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  3. Kinya Yokoyama
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  4. Kenji Uda
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  5. Takashi Mamiya
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  6. Masahiro Nishihori
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  7. Takashi Izumi
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  8. Sho Okamoto
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  9. Atsushi Natsume
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Contributions

Conceptualization: Fumiaki Kanamori, Yoshio Araki. Methodology: Fumiaki Kanamori, Kinya Yokoyama. Formal analysis and investigation: Fumiaki Kanamori, Kenji Uda, Takashi Mamiya, Masahiro Hishihori, Takashi Izumi. Writing—original draft preparation: Fumiaki Kanamori; Supervision: Sho Okamoro, Atsushi Natsume.

Corresponding author

Correspondence to Fumiaki Kanamori.

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The authors declare that they have no conflict of interest.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of the Nagoya University Graduate School of Medicine (No. 2016-0327).

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Informed consent was obtained from all study participants or their legal guardians.

The participants provided informed consent regarding publishing their data and photographs.

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This article is part of the Topical Collection on Vascular Neurosurgery - Other

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Kanamori, F., Araki, Y., Yokoyama, K. et al. Effects of aspirin and heparin treatment on perioperative outcomes in patients with Moyamoya disease. Acta Neurochir 163, 1485–1491 (2021). https://doi.org/10.1007/s00701-020-04668-0

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  • DOI: https://doi.org/10.1007/s00701-020-04668-0

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