Abstract
Background
This study aims to elucidate the clinical and theoretical value of directly measuring donor and recipient arterial pressure pre- and post-superficial temporal artery- middle cerebral artery (STA-MCA) bypass in moyamoya disease (MMD) patients.
Methods
DSA imaging data were prospectively collected from patients diagnosed with bilateral MMD who underwent STA-MCA bypass surgery between 2022 and 2023 and stratified according to the Suzuki stage. The mean arterial pressure (MAP) of the donor and recipient arteries was directly measured during the STA-MCA bypass procedure, and these data were statistically analysed and evaluated.
Results
Among 48 MMD patients, Suzuki grading revealed that 43.8% were in early stages (II and III), while 56.2% were in advanced stages (IV, V, and VI). Predominantly, 77.1% presented with ischemic-type MMD, and 22.9% with hemorrhagic type. Pre-bypass assessments showed that 62.5% exhibited antegrade blood flow direction and 37.5% had retrograde. The mean recipient artery pressure was 35.0 ± 2.3 mmHg, with a mean donor-recipient pressure gradient (?P) of 46.4 ± 2.5 mmHg between donor and recipient arteries. Post-bypass, mean recipient artery pressure increased to 73.3 ± 1.6 mmHg. No significant correlation (r = 0.18, P = 0.21) was noted between ?P and Suzuki staging.
Conclusion
While Suzuki staging offers a morphological description of the cerebral arterial system, preoperative decisions regarding the revascularization procedure in MMD patients should consider the pressure characteristics of the cortical arteries. Our findings provide objective criteria that choosing the anastomosis site in the downstream blood flow of the recipient is a reasonable choice.
