FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2887071105> ?p ?o ?g. }

• W2887071105 endingPage "65" @default.
• W2887071105 startingPage "62" @default.
• W2887071105 abstract "JAM: Japan Adult Moyamoya MMD: moyamoya disease STA: superficial temporal artery Moyamoya disease (MMD), an uncommon chronic cerebrovascular disorder, is characterized by stenosis or occlusion of the intracranial part of the bilateral internal carotid arteries with abnormal vascular collateral networks at the base of the brain.2,3 Although MMD is a less common cerebrovascular 2, it is one important etiological factor for stroke in children.4-6 In Asian populations, there are 2 phenotypes of MMD: ischemic type and hemorrhagic type. The disease has a bimodal age of presentation. Ischemic type is commonly diagnosed in children, while hemorrhagic type is frequently seen in adults. 7-10 Both improving symptoms and preventing recurrent strokes is the goal of the treatment of MMD.11,12 For the past few decades, revascularization surgery for symptomatic MMD has been considered useful for preventing further strokes.13 Many studies have shown that revascularization surgery is effective in the treatment of ischemic MMD, particularly in children5,6,14,15 Although there has been a lot of debate on the ideal treatment procedures for hemorrhagic MMD, many surgeons perform surgical revascularization to prevent rebleeding.16-18 Recently, a randomized controlled study in Japan showed that direct surgical revascularization was useful in preventing rebleeding and improving prognosis in the adult hemorrhagic-type MMD patients.16 However, we think the optimal surgical procedure for both ischemic and hemorrhagic MMD still remains controversial.19 Here, we present a review on this disease, which focused on the treatment of MMD. MEDICAL TREATMENT FOR MMD Medical treatment has been used in MMD patients, especially when the patient has only slight symptoms or none at all or the revascularization with high risks.1,13 However, the appropriate medical treatment instead, before or after surgical revascularization, is almost completely ignored by scientific reports.20,21 Some physicians, particularly in western countries, are using aspirin to prevent strokes in MMD patients, and the majority of experts hold the idea that there is no need for long-term antiplatelet treatment.22 In addition, most Asian experts think that antiplatelet treatment is not useful in improving blood supply and it carries the risk of potential hemorrhagic complications. In contrast, the supporters hold the idea that antiplatelet drugs may improve microcirculation and prevent recurrent strokes. So far, limited evidence has shown that antiplatelet treatment is effective in preventing further strokes in MMD. Recently, there were 4 studies regarding the antiplatelet treatment of MMD. The first study was about aspirin resistance in patients who suffered from ischemia and received direct surgical procedures.20 It reported that aspirin resistance might deteriorate the prognosis of these patients. The second study was about the effects of surgery and antiplatelet therapy on MMD with long-term follow-up.23 It showed that antiplatelet therapy did not reduce recurrent strokes in patients with ischemic MMD, whereas it lowered the rate of bleeding in hemorrhagic MMD. The third study was about prehospital antiplatelet use and functional status on hospital admission of nonhemorrhagic MMD patients.24 It reported that prehospital antiplatelet use could improve functional status on admission for patients with nonhemorrhagic MMD in Japan. The fourth study was about postoperative aspirin use in adult ischemic MMD.25 It showed that aspirin might not decrease the incidence of postoperative ischemic stroke or increase patency rate of bypass graft, but it did not increase the risk of hemorrhages either. In summary, the dose and timing of aspirin administration and applicable patients before and after bypass surgery for MMD has not been standardized yet. Most usage of antiplatelet therapy has been empirical, and there is lack of placebo-controlled, randomized studies. Indication of Surgical Bypass for MMD No known surgical bypass will reverse the MMD process, and the most important goal of surgical bypass is to reduce recurrent ischemic or hemorrhagic strokes, and to improve neurological functions.26,27 Generally accepted indications for revascularization are as follows: (1) clinical symptoms due to ischemic or hemorrhagic strokes; (2) decreased cerebral blood flow, vascular response, and perfusion reserve.13 According to the Japanese guidelines for the management of stroke published in 2015, it is recommended that revascularization surgery be performed for ischemic MMD.28 However, the surgical management of hemorrhagic MMD is still controversial.16,29-31 But many studies have also suggested the significance of bypass procedures in the treatment of adult hemorrhagic MMD. The results of the Japan Adult Moyamoya (JAM) trial revealed that the direct bypass could prevent rebleeding in adult hemorrhagic MMD. These results supported that bypass procedures should be performed in patients with hemorrhagic MMD.16 What`s more, the revascularization surgeries for MMD include direct, indirect, and combined procedures. However, because of the heterogeneity of MMD, the optimal surgical procedures for both ischemic and hemorrhagic MMD remain unclear. Indirect Bypass for MMD The indirect bypass brings blood supply to the surgical brain areas by introducing newly developed vasculatures.32 Indirect bypass is especially useful for patients without good dominant or recipient branches for anastomosis.33 Further, indirect bypass is relatively easier to perform compared to direct bypass, which shortens the operation time and reduced intraoperative complications.34 In addition, postoperative hyperperfusion syndrome was rarely seen after indirect bypass.11 However, it needs more time to improve cerebral perfusion.35 There are many types of indirect bypass procedures, including encephalo-duro-arterio-synangiosis, encephalo-myo-synangiosis, the multiple burr hole surgery technique, ribbon encephalo-duro-arterio-myo-synangiosis, encephalo-duro-myo-arterio-pericranio-synangiosis, omentum transplantation, etc.36-38 Direct Bypass for MMD Direct bypass mainly refers to superficial temporal artery (STA) to middle cerebral artery anastomosis, which can immediately improve the cerebral perfusion in the surgical regions.39 However, this procedure is challenging and requires surgeons who received years of rigorous training and great skills. Direct bypass demands that the vascular diameters of the STA and cortical arteries are big enough. In children or patients with MMD at late Suzuki stage, the tiny or fragile vessels make this procedure more challenging. In addition, direct bypass could increase cerebral perfusion immediately after revascularization, but it also might lead to symptomatic hyperperfusion.40 Combined Bypass for MMD Direct and indirect bypass could be combined to obtain immediate increased blood flow and benefit from the diffuse neovascularization that develops over time, which was named as combined bypass.41,42 Some authors considered that combined bypass is the most effective technique.43,44 However, some studies revealed no difference in clinical outcomes between combined bypass and direct/indirect bypass despite the angiographic superiority of combined surgery.45 Medical Treatment vs Surgical Treatment Recently, some studies have reported that revascularization surgery is effective in the treatment of ischemic MMD, particularly in children. However, there has been a lot of debate on ideal treatment regimens for hemorrhagic MMD.46 Bypass procedures can reduce moyamoya vessels and hemodynamic stress in MMD. Theoretically, it should reduce the incidence of recurrent hemorrhage. However, there are a lot of debates about the ideal treatment of hemorrhagic MMD.47 Ikezaki et al48 conducted a nationwide survey, and revealed that rebleeding was less frequent in surgically treated patients than conservatively treated patients, but there was no statistical difference. Fuji et al49 performed a multicenter retrospective study which found that there was no statistical difference in rebleeding rate between surgical and conservative treatments. However, the results of the JAM trial, which was a multicentered, prospective, randomized, controlled trial performed in Japan, revealed that direct bypass could prevent the recurrent bleeding.16 In addition, long-term outcome after conservative and surgical treatment of hemorrhagic MMD in our previous study, which also reported revascularization surgery, can improve regional blood flow and have greater efficacy at preventing rebleeding than conservative treatment.29 In a word, there is limited evidence supporting the long-term benefits of bypass surgeries in the prevention of recurrent hemorrhage in hemorrhagic MMD. It is well known that recurrent bleeding may occur >10 yr after the first attack,50 and we posit that more multicentered, prospective, randomized, controlled trials with longer follow-up (more than 10 yr) are needed in the future. Direct Bypass vs Indirect Bypass Because the heterogeneity (for example, age, disease type, Suzuki stage) of MMD could generate differences in surgical outcomes in different studies, the optimal surgical procedure for this disease remains controversial.26 Theoretically, direct bypass can immediately increase cerebral perfusion and reduce ischemic and hemorrhagic attacks immediately after surgery, whereas indirect bypass requires 3 to 4 mo for neovascularization by introducing newly developed vasculature from sutured tissue.11 However, there are some drawbacks to both direct bypass and indirect. Direct bypass requires both good donor and recipient arteries, which do not exist in some patients. Moreover, direct bypass might also lead to symptomatic hyperperfusion or even hemorrhage. In contrast, indirect bypass is considered easier and safer to perform. The shortened operation time is important in preventing intraoperative and postoperative complications. However, it takes 3 to 4 mo for neovascularization to improve cerebral blood flow, rather than immediately. And it has also been reported that neovascularization may not occur in about 40% to 50% of adult patients.2,34 Currently, some surgeons prefer direct bypass over indirect bypass.51 Jeon et al52 conducted a meta-analysis to compare direct bypass and indirect bypass, in terms of the perioperative complications, angiographic revascularization, and recurrent strokes in adult MMD patients. They concluded that direct bypass seemed to prevent recurrent strokes better than indirect bypass in MMD patients.52 In addition, Kim et al53 also concluded that the direct or combined bypass surgical method was better in angiographic revascularization in adult MMD patients. What`s more, recently, we reported a prospective cohort study regarding the surgical treatment for MMD, which concluded that combined and direct surgical procedures are more effective at preventing recurrent ischemic strokes than indirect bypass. But there is no difference in preventing rebleeding among the 3 surgical procedures.12 Deng et al51 also reported a propensity score-matched analysis of direct vs indirect bypasses for adult ischemic-type MMD, in which they concluded that direct bypass is more effective in preventing recurrent ischemic strokes than indirect bypass for adult ischemic-type MMD. Other studies, however, reported no advantages of direct bypass. Macyszyn et al45 reported that the direct bypass could not improve the quality-adjusted life in both adults and children. They suggested that indirect and combined bypass might offer optimal results at long-term follow-up.45 In addition, Park et al54 also reported that both direct bypass and indirect bypass could prevent recurrent stroke in symptomatic adults with MMD. However, when considering the advantages and disadvantages of the 2 procedures, the authors intended to choose the indirect bypass, an easier and shorter time surgery with fewer complications for the treatment of symptomatic adult MMD.54 Furthermore, Duan et al6 reported that patients had low rates of postoperative ischemic or hemorrhagic strokes, and the majority of patients had preserved functional status after indirect revascularization. Starke et al55 also reported that indirect bypass improved the microcirculation and increased the perfusion in the adult MMD patients in a mixed-race population of North American patients. In summary, the optimal surgical procedure for MMD remains controversial. Each procedure has its advantages and disadvantages. The option of surgery depends on the surgeon's ideas and skills and the situation of donor and recipient arteries. We believe that more studies are needed to find the best treatment modality for MMD patients. CONCLUSION Both medical and surgical treatment should be included in the treatment of MMD. For medical treatment, antiplatelet treatment should be taken seriously. For surgical treatment, the optimal surgical procedure for MMD remains controversial. Randomized prospective clinical trials are needed in the future. Disclosures This study was granted by the National Science and Technology Major Project of China (2015BAI12B04), the Program of Beijing Municipal Science and Technology Commission (Z13110200680000), the Program of the National Natural Science Foundation of China (81 371 292), and Beijing Municipal Administration of Hospitals’ Mission Plan (SML20150501). The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article." @default.
• W2887071105 created "2018-08-22" @default.
• W2887071105 creator A5003603466 @default.
• W2887071105 creator A5004483141 @default.
• W2887071105 creator A5010275776 @default.
• W2887071105 creator A5024889939 @default.
• W2887071105 creator A5038816109 @default.
• W2887071105 creator A5050464467 @default.
• W2887071105 creator A5086664284 @default.
• W2887071105 date "2018-09-01" @default.
• W2887071105 modified "2023-10-18" @default.
• W2887071105 title "Treatment of Moyamoya Disease" @default.
• W2887071105 cites W1514655238 @default.
• W2887071105 cites W1640759503 @default.
• W2887071105 cites W1764408364 @default.
• W2887071105 cites W1923800940 @default.
• W2887071105 cites W1944187276 @default.
• W2887071105 cites W1966545151 @default.
• W2887071105 cites W1973373552 @default.
• W2887071105 cites W1983078335 @default.
• W2887071105 cites W1998755198 @default.
• W2887071105 cites W2000758240 @default.
• W2887071105 cites W2003146718 @default.
• W2887071105 cites W2009735073 @default.
• W2887071105 cites W2017329647 @default.
• W2887071105 cites W2019890975 @default.
• W2887071105 cites W2021245959 @default.
• W2887071105 cites W2023113510 @default.
• W2887071105 cites W2030084908 @default.
• W2887071105 cites W2032538423 @default.
• W2887071105 cites W2037923887 @default.
• W2887071105 cites W2057543245 @default.
• W2887071105 cites W2063803064 @default.
• W2887071105 cites W2068607675 @default.
• W2887071105 cites W2072732025 @default.
• W2887071105 cites W2090129107 @default.
• W2887071105 cites W2097330801 @default.
• W2887071105 cites W2098126126 @default.
• W2887071105 cites W2100579712 @default.
• W2887071105 cites W2103615722 @default.
• W2887071105 cites W2108841441 @default.
• W2887071105 cites W2118366441 @default.
• W2887071105 cites W2124164573 @default.
• W2887071105 cites W2125929628 @default.
• W2887071105 cites W2130514778 @default.
• W2887071105 cites W2136214045 @default.
• W2887071105 cites W2136856533 @default.
• W2887071105 cites W2140228379 @default.
• W2887071105 cites W2148940134 @default.
• W2887071105 cites W2149672895 @default.
• W2887071105 cites W2175551682 @default.
• W2887071105 cites W2291528898 @default.
• W2887071105 cites W2292199645 @default.
• W2887071105 cites W2307177980 @default.
• W2887071105 cites W2473087618 @default.
• W2887071105 cites W2481226498 @default.
• W2887071105 cites W2509555622 @default.
• W2887071105 cites W2551593977 @default.
• W2887071105 cites W2590264058 @default.
• W2887071105 cites W2626893151 @default.
• W2887071105 cites W4250897659 @default.
• W2887071105 doi "https://doi.org/10.1093/neuros/nyy114" @default.
• W2887071105 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/31076784" @default.
• W2887071105 hasPublicationYear "2018" @default.
• W2887071105 type Work @default.
• W2887071105 sameAs 2887071105 @default.
• W2887071105 citedByCount "20" @default.
• W2887071105 countsByYear W28870711052019 @default.
• W2887071105 countsByYear W28870711052020 @default.
• W2887071105 countsByYear W28870711052021 @default.
• W2887071105 countsByYear W28870711052022 @default.
• W2887071105 countsByYear W28870711052023 @default.
• W2887071105 crossrefType "journal-article" @default.
• W2887071105 hasAuthorship W2887071105A5003603466 @default.
• W2887071105 hasAuthorship W2887071105A5004483141 @default.
• W2887071105 hasAuthorship W2887071105A5010275776 @default.
• W2887071105 hasAuthorship W2887071105A5024889939 @default.
• W2887071105 hasAuthorship W2887071105A5038816109 @default.
• W2887071105 hasAuthorship W2887071105A5050464467 @default.
• W2887071105 hasAuthorship W2887071105A5086664284 @default.
• W2887071105 hasBestOaLocation W28870711051 @default.
• W2887071105 hasConcept C126838900 @default.
• W2887071105 hasConcept C2776548475 @default.
• W2887071105 hasConcept C71924100 @default.
• W2887071105 hasConceptScore W2887071105C126838900 @default.
• W2887071105 hasConceptScore W2887071105C2776548475 @default.
• W2887071105 hasConceptScore W2887071105C71924100 @default.
• W2887071105 hasIssue "CN_suppl_1" @default.
• W2887071105 hasLocation W28870711051 @default.
• W2887071105 hasLocation W28870711052 @default.
• W2887071105 hasOpenAccess W2887071105 @default.
• W2887071105 hasPrimaryLocation W28870711051 @default.
• W2887071105 hasRelatedWork W1506200166 @default.
• W2887071105 hasRelatedWork W1995515455 @default.
• W2887071105 hasRelatedWork W2048182022 @default.
• W2887071105 hasRelatedWork W2080531066 @default.
• W2887071105 hasRelatedWork W2604872355 @default.
• W2887071105 hasRelatedWork W2748952813 @default.

• next