Predictive factors for acute thrombogenesis occurring immediately after bypass procedure for moyamoya disease

• DOI: 10.1007/s10143-019-01086-4
• Publication Date: 2019-02-14T11:00:41Z
• Authors: Takeshi Mikami; Hime Suzuki; Ryo Ukai; Katsuya Komatsu; Yukinori Akiyama; Masahiko Wanibuchi; Kiyohiro Houkin; Nobuhiro Mikuni
• Keywords: Adult; Male; Time Factors; Adolescent; Cerebral Revascularization; Incidence; Middle Aged; 3. Good health; Young Adult; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Risk Factors; Humans; Female; Intracranial Thrombosis; Moyamoya Disease; Child; Magnetic Resonance Angiography; Aged; Retrospective Studies

Extracranial-to-intracranial (EC-IC) bypass surgery is an effective treatment for patients with moyamoya disease and other conditions. Some patients with moyamoya disease have a risk of acute thrombogenesis at the anastomotic site just after bypass surgery. The purpose of this study was to study risk factors of acute thrombogenesis and determine effective countermeasures. This study included 48 patients (66 EC-IC bypass procedures) with moyamoya disease and 52 controls (54 procedures) without moyamoya disease. The development of acute thrombogenesis was compared between the moyamoya disease and control groups. In the moyamoya disease group, clinical and radiological characteristics were assessed with respect to acute thrombogenesis. In the patients with acute thrombogenesis, causes of technical problems were retrospectively examined. The incidence of acute thrombogenesis was significantly higher in the moyamoya disease group than those in the control group. In the moyamoya disease group, acute thrombogenesis was observed in seven patients. In the moyamoya disease group, the magnetic resonance angiography (MRA) scores were significantly higher in patients with acute thrombogenesis than those in the patients without acute thrombogenesis. In the multivariate analysis, the predictive factor of acute thrombogenesis in moyamoya disease was a high MRA score (odds ratio, 2.336; p = 0.009). During EC-IC bypass surgery for moyamoya disease, acute thrombogenesis should be considered to obtain a high patency rate, particularly in patients with high MRA scores. Acute thrombogenesis will not influence morbidity if proper countermeasures are followed; therefore, the prediction and recognition of white thrombus are important for a successful bypass surgery.