1019. Additional Revascularization Surgery for Progressing Steno-occlusive Posterior Cerebral Artery Lesions in Patients with Moyamoya Disease

Authors: Yutaro Fuse; Syuntaro Takasu, MD, PhD; Yugo Kishida, MD, PhD; Yukio Seki, MD, PhD (Nagoya, Japan)

Introduction:

Moyamoya disease (MMD) is a steno-occlusive cerebrovascular disorder characterized by stenosis of the internal carotid arteries that leads to the formation of abnormal vessels. It is reported that steno-occlusive posterior cerebral artery (PCA) lesions in MMD are related to increased incidence of brain infarction. We evaluated the presence of PCA stenosis before anterior circulation revascularization surgery and the progression of PCA lesions during the follow-up period. We also assessed the efficacy of additional revascularization surgery for MMD patients with progressing PCA lesions.

Methods:

We retrospectively reviewed MMD patients who underwent revascularization surgery between April 2007 and July 2018 in our institute. The presence of PCA stenosis before and after anterior circulation revascularization surgery were assessed in 139 patients. The efficacy of additional revascularization surgery for PCA lesions was also investigated.

Results:

There were 39 pediatric MMD patients (< 16 years old) and 100 adult MMD patients. Eight pediatric patients (21%) had steno-occlusive PCA lesions at the time of the initial diagnosis, while 21 adult patients (21%) did. The incidence of progressing steno-occlusive PCA lesions after anterior circulation revascularization surgery was significantly higher in children (10 patients, 26%)than in adults (7 patients, 7%) (p=0.003). Four pediatric patients and 1 adult patient underwent additional revascularization surgery for posterior circulation, all of whom showed symptomatic and/or radiological improvement after surgery.

Conclusion:

The prevalence of steno-occlusive PCA lesions in MMD was almost the same between pediatric and adult patients. On the other hand, pediatric patients are more likely to develop steno-occlusive PCA lesions during postoperative follow-up period than adult patients. Long-term postoperative follow-up is necessary to detect progression of PCA stenosis. The additional revascularization surgery for posterior circulation is effective for improving clinical symptoms and radiological findings in patients with MMD who showed progression of PCA stenosis.