Related Experiment Video
Updated: Dec 30, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Postoperative collateral formation after indirect bypass for hemorrhagic moyamoya disease
Peicong Ge1,2,3,4,5, Qian Zhang1,2,3,4,5, Xun Ye1,2,3,4,5
1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
Background:
The research on postoperative collateral formation for hemorrhagic moyamoya disease (MMD) evaluated by using digital subtraction angiography (DSA) is limited. Our study objective was to investigate the postoperative collateral formation after indirect bypass for hemorrhagic MMD.
Methods:
All consecutive inpatients with hemorrhagic MMD who received indirect bypass at Beijing Tiantan Hospital, Capital Medical University from January 2010 through December 2018 were screened. The site of the hemorrhage was classified as either anterior or posterior. Postoperative collateral formation was evaluated on lateral views using the Matsushima scale. Univariate and multivariate logistic regression analyses were carried out to determine the factors influencing postoperative collateral formation.
Results:
Six-four patients (64 hemispheres) were included in this study. After a median 8.5 months DSA follow-up, 14 (21.9%) hemispheres had grade A collateral circulation, 13 (20.3%) had grade B, and 37 (57.8%) had grade C. Twenty-seven (42.2%) hemispheres had good postoperative collateral formation and 37 (57.8%) had poor postoperative collateral formation. The univariate logistic regression analyses showed that age at operation (OR, 0.954; 95% CI, 0.908-1.003; p = 0.066), hemorrhagic site (OR, 4.694; 95% CI, 1.582-13.923; p = 0.005), and PCA involvement (OR, 3.474; 95% CI, 0.922-13.086; p = 0.066) may effect postoperative collateral formation. The multivariate logistic regression analyses showed that only anterior hemorrhage (OR, 5.222; 95% CI, 1.605-16.987; p = 0.006) was significantly related to good postoperative collateral formation.
Conclusion:
Anterior hemorrhage was significantly related to good postoperative collateral formation after indirect bypass.
Insights
Anterior hemorrhage in moyamoya disease (MMD) patients undergoing indirect bypass surgery is linked to better postoperative collateral formation. This finding aids in predicting outcomes for hemorrhagic MMD. Keywords: moyamoya disease, indirect bypass, collateral formation, hemorrhage.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Radiology
Background:
- Limited research exists on postoperative collateral formation in hemorrhagic moyamoya disease (MMD) using digital subtraction angiography (DSA).
- Indirect bypass is a surgical option for MMD, but its impact on collateral development requires further investigation.
Purpose of the Study:
- To investigate the formation of collateral circulation after indirect bypass surgery in patients with hemorrhagic moyamoya disease.
- To identify factors influencing postoperative collateral development.
Main Methods:
- Retrospective analysis of 64 hemispheres from patients with hemorrhagic MMD who underwent indirect bypass.
- Classification of hemorrhage site (anterior/posterior) and evaluation of collateral formation using the Matsushima scale on DSA.
- Univariate and multivariate logistic regression analyses to determine predictive factors.
Main Results:
- Postoperative collateral formation was graded using the Matsushima scale, with 57.8% showing poor formation.
- Univariate analysis suggested age, hemorrhagic site, and PCA involvement as potential factors.
- Multivariate analysis revealed anterior hemorrhage as the only significant predictor of good collateral formation (OR, 5.222; p=0.006).
Conclusions:
- Anterior hemorrhage is significantly associated with good postoperative collateral formation following indirect bypass in hemorrhagic MMD.
- This finding may help in predicting surgical outcomes and guiding treatment strategies for MMD.
