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Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...

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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Direct Versus Indirect Revascularization for Moyamoya: a Large Multicenter Study.

Kareem El Naamani1, Ching-Jen Chen2, Roland Jabre1

  • 1Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

Journal of Neurology, Neurosurgery, and Psychiatry
|September 6, 2023
PubMed
Summary

Direct and indirect revascularization surgery offer similar stroke rates for moyamoya disease. Both surgical options are viable, with patient risk assessment guiding the best choice for treating this cerebrovascular condition.

Keywords:
CEREBROVASCULAR DISEASESTROKEVASCULAR SURGERY

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Area of Science:

  • Neurology
  • Neurosurgery
  • Vascular Surgery

Background:

  • Moyamoya disease is a chronic cerebrovascular condition characterized by neovascularization.
  • Surgical revascularization is the primary treatment, but consensus on the optimal modality is lacking.

Purpose of the Study:

  • To compare the outcomes of direct revascularization (DR) and indirect revascularization (IR) for moyamoya disease.
  • To evaluate the efficacy of DR versus IR in reducing stroke rates.

Main Methods:

  • A multicenter retrospective study of moyamoya-affected hemispheres treated with DR and IR surgeries.
  • Included 515 hemispheres across 13 academic institutions, predominantly in North America.
  • Primary outcome was the rate of symptomatic strokes.

Main Results:

  • Comparable rates of symptomatic strokes between DR (11.6%) and IR (9.6%) cohorts.
  • Slightly higher perioperative stroke rate in the DR cohort (6.1% vs 2.0%).
  • Slightly higher follow-up stroke rate in the IR cohort (8.1% vs 6.6%).

Conclusions:

  • Both direct and indirect revascularization demonstrate comparable overall stroke rates in moyamoya disease.
  • The choice between DR and IR should be based on individual patient risk assessment.
  • Both surgical modalities are effective treatment options for moyamoya disease.