ИСТИНА

Background: Aim of the study was to compare impacts of STA-MCA bypass and different types of indirect synangiosis on angiogenesis, cerebral perfusion and clinical outcome during follow up in order to justify combined revascularization approach for patients with Moya-moya disease (MMD). Methods: From 2008 to 2019 66 patients with MMD were observed in our Center: 19 adults and 47 children. Surgical treatment for revascularization of MCA territory was performed in 99 hemispheres (27 hemispheres in adults, 72 hemispheres in children). Indirect revascularization was performed in 15 patients (26 hemispheres) and was represented by encephaloduroarteriosynangiosis (23 hemispheres) and pial synangiosis (3 hemispheres). Direct revascularization was performed in 15 patients (20 hemispheres) and was represented by STA-MCA bypass. Combined revascularization was performed in 40 patients (53 hemispheres) and included STA-MCA bypass (single in 42 cases, double in 10 cases and triple in 1 case) plus indirect component - encephalodurosynangiosis (15 hemispheres), encephaloduromyosynangiosis (12 hemispheres), encephaloduroarteriosynangiosis (22 hemispheres), encephaloduroarteriomyosynangiosis (3 hemispheres) and cranial bur holes (4 hemispheres). Follow-up period was up to 10 years (mean 4,5 years). Results: Immediately after the operation improvement of symptoms was seen in 53,3% after direct revascularization, in 15% after combined revascularization. In long-term follow-up there was 66,7% improvement in group of direct revascularization, 65% of combined revascularization and 50% of indirect revascularization. Perioperative ischemic complications were seen more often after indirect revascularizations (8,7%, n = 2). There were 5% of complications after combined revascularization and no complications after direct revascularization. Conclusions: All types of revascularization show good clinical outcomes in long-term follow-up. However direct bypass starts to work immediately after the operation so has better short-term results. Indirect synangiosis, in contrast, requires time to achieve effect. So optimal strategy for treatment patients with MMD will be combined revascularization with good clinical outcomes and acceptable level of morbidity.