scholarly journals Partial resolution of cerebrovascular stenosis after conservative treatment of moyamoya disease

2020 ◽  
Vol 31 (4) ◽  
pp. 357-361
Author(s):  
Gustavo Tedde Filho ◽  
Mariana Silva Nunes ◽  
Marcelle Rehem Machado ◽  
Bruno de Sousa Mendes Parente ◽  
Eduardo Waihrich
Keyword(s):  
Conservative Treatment ◽  
Moyamoya Disease ◽  
Partial Resolution ◽  
Cerebrovascular Stenosis

Relatamos o caso de um paciente masculino, 28 anos de idade, sem histórico de descendência oriental, que procurou atendimento após apresentar dois quadros de hemiparesia esquerda reversível em um intervalo de seis meses. Lesões isquêmicas não foram evidenciadas nas tomografias computadorizadas (TC) de crânio. O diagnóstico de doença de moyamoya foi confirmado por meio da angiografia cerebral diagnóstica com subtração. A revascularização cirúrgica foi proposta, porém recusada pelo paciente. Iniciou-se tratamento não invasivo com mono-antiagregação plaquetária e rosuvastatina, obtendo-se regressão parcial da estenose.

scholarly journals Clinical Characteristics and Long-Term Outcome of Headaches Associated With Moyamoya Disease in the Chinese Population—A Cohort Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Bin Gao ◽  
Kaijiang Kang ◽  
Jia Zhang ◽  
Dong Zhang ◽  
Xingquan Zhao
Keyword(s):  
Conservative Treatment ◽  
Moyamoya Disease ◽  
Chinese Population ◽  
Chinese Patients ◽  
Surgical Revascularization ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Follow Up

Background: Headache associated with Moyamoya disease (HAMD) in the Chinese population is not well-described. The long-term outcome of surgical revascularization and natural course of HAMD has not been disclosed either.Methods: A headache screening questionnaire in China based on the ICHD2 and a face-to-face interview performed by an experienced neurologist were used to investigate headache characteristics and frequency and pain intensity in the 3 months before admission, and a telephone interview was used for the follow-up of a large cohort of 119 Chinese patients with HAMD.Results: Headache intensity was rated as scores of 5.9 ± 2.0 on a visual analog scale (VAS), ranging from 0 to 10, in the 3 months before admission. Forty-six patients (38.6%) were categorized as having migraine-like headaches, 29 patients (24.3%) were categorized as having tension type-like headaches, and 44 patients (36.9%) had a combination of both. The majority of patients had migraine-like headaches (n = 34, 73.9%) with a migrainous aura. Both the frequency and intensity of the headache improved significantly in patients treated with surgical revascularization (n = 96, 80.7%) or the conservative treatment (n = 23, 19.3%) in a long-term follow-up.Conclusion: HAMD frequently presented with a migraine-like headache (75.5% in total). A tension type headache was present in 60.9% of patients. The symptom of dizziness is common in patients with HAMD (60.5%), and 19 of them (26.4%) met the diagnose of vestibular migraine. Both intensity and frequency of HAMD show a trend of spontaneous remission in a long-term follow-up, and there is no difference in long-term outcomes of HAMD between surgical revascularization and conservative treatment, which indicates that the effect of bypass intervention on HAMD may be a placebo effect.

Long-Term Outcome After Conservative Treatment and Direct Bypass Surgery of Moyamoya Disease at Late Suzuki Stage

2017 ◽  
Vol 103 ◽  
pp. 283-290 ◽  
Author(s):  
Peicong Ge ◽  
Qian Zhang ◽  
Xun Ye ◽  
Xingju Liu ◽  
Xiaofeng Deng ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Direct Bypass

Encephaloduroateriosynangiosis versus conservative treatment for patients with moyamoya disease at late Suzuki stage

2018 ◽  
Vol 50 ◽  
pp. 277-280 ◽  
Author(s):  
Peicong Ge ◽  
Xun Ye ◽  
Qian Zhang ◽  
Dong Zhang ◽  
Shuo Wang ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Moyamoya Disease

Treatment of ruptured aneurysms of the choroidal collateral system in moyamoya disease: a systematic review and data analysis

2021 ◽  
pp. 1-10
Author(s):  
Markus K. H. Wiedmann ◽  
Chris Davidoff ◽  
Anna Lo Presti ◽  
Wei Ni ◽  
Jong Kook Rhim ◽  
...  
Keyword(s):  
Treatment Group ◽  
Data Collection ◽  
Conservative Treatment ◽  
Moyamoya Disease ◽  
Case Series ◽  
Unknown Etiology ◽  
High Morbidity ◽  
Ruptured Aneurysms ◽  
Data Collection And Analysis ◽  
Collateral System

OBJECTIVE Moyamoya disease (MMD) is a chronic, progressive steno-occlusive condition of the distal internal carotid arteries of unknown etiology. Collateral arterial networks typically develop in MMD, bypassing the steno-occlusion. Aneurysms arising on the collateral networks are a known source of hemorrhage. The choroidal collateral system is the most common location for collateral pathway aneurysms in MMD and associated hemorrhage. The authors performed data collection and analysis to further elucidate the best treatment approaches for ruptured aneurysms of the choroidal collateral system in MMD, which as yet remain unclear. METHODS A comprehensive data collection and analysis of case reports and case series with ruptured choroidal collateral artery aneurysms (CCAAs) was performed. PRISMA guidelines for systematic reviews were followed and the Medline, Embase, and Scopus databases were searched for relevant studies. A database was created including patients with ruptured CCAA in MMD. Original data from case series were included whenever possible. A previously unreported case of a ruptured choroidal artery aneurysm in MMD treated by the authors was also included. RESULTS The database comprised 72 patients with ruptured CCAA in MMD. The most common clinical symptoms were headache, nausea, and vomiting (39%). Initially, a conservative treatment approach was chosen in 29% of cases but led to rehemorrhage in 40% of cases; 63% of these rehemorrhages occurred during the first 35 days. Endovascular treatment seemed a safe option for aneurysm exclusion, mainly through parent vessel sacrifice, but had a treatment failure rate of 21%, due to inadequate access. Aneurysm treatment with revascularization as the initial treatment strategy led to aneurysm regression in 82% with no reported rehemorrhage. Aneurysm exclusion through open surgery was effective but was associated with a relatively high complication rate (25%). Outcome after rupture of CCAA was poor, with 41% of patients deceased or permanently disabled. Overall, patient outcomes were better in the endovascular and revascularization treatment group than in the conservative treatment group. CONCLUSIONS Rupture of CCAA in MMD is associated with high morbidity and rerupture rate requiring urgent treatment.

Very distal vein bypass in patients with thromboangiitis obliterans

VASA ◽  
2017 ◽  
Vol 46 (4) ◽  
pp. 304-309 ◽  
Author(s):  
Achim Neufang ◽  
Carolina Vargas-Gomez ◽  
Patrick Ewald ◽  
Nicolaos Vitolianos ◽  
Tolga Coskun ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Vein Graft ◽  
Duplex Ultrasound ◽  
Critical Limb Ischaemia ◽  
Thromboangiitis Obliterans ◽  
Surgical Revascularization ◽  
Autologous Vein ◽  
Therapeutic Concept ◽  
Autologous Vein Graft ◽  
Vein Bypass

Abstract. Background: Surgical revascularization for chronic critical limb ischaemia in patients with thromboangiitis obliterans (TAO) still remains controversial. Generally, besides cessation of smoking, conservative treatment supported by intravenous administration of vasoactive agents is regarded as the treatment of choice, in combination with local wound therapy or minor amputation. Patients and methods: In four male patients (42-47 years) surgical revascularization was chosen as therapy for established gangrene or non-healing ulceration after unsuccessful conservative treatment and cessation of smoking. Angiography was able to identify a suitable distal arterial segment for the bypass which was revascularized by means of an autologous vein graft. Grafts were followed with repetitive duplex ultrasound. Revision of the bypass graft was initiated if indicated by pathological duplex findings. Results: In all cases a bypass could be constructed with either the ipsilateral greater saphenous vein or arm veins. A distal origin configuration was possible in three cases with popliteo-pedal or cruro-pedal bypasses. In the fourth case the distal superficial femoral artery was used for inflow. Two early graft thromboses underwent successful revision. During follow-up, duplex ultrasound identified graft stenoses in three bypasses which were successfully treated with endovascular techniques. All grafts are patent with complete resolution of ischaemic symptoms after 46, 42, 32, and 29 months. The patients remained non-smokers and returned to a professional life. Conclusions: Surgical therapy with distal vein bypass for persistent ischaemic symptoms after definitive cessation of smoking seems feasible in selected cases with TAO and a suitable distal artery. Close follow-ups of the patients with duplex ultrasound are necessary to identify developing vein graft stenoses. Angioplasty seems to be an important part of the long-term therapeutic concept.

Penetrating atherosclerotic ulcer aneurysm of the innominate artery

VASA ◽  
2009 ◽  
Vol 38 (3) ◽  
pp. 263-266 ◽  
Author(s):  
Yuan ◽  
Tager
Keyword(s):  
Conservative Treatment ◽  
Thoracic Aorta ◽  
Open Surgery ◽  
Innominate Artery ◽  
Ruptured Aneurysm ◽  
Descending Thoracic Aorta ◽  
Penetrating Atherosclerotic Ulcer ◽  
Descending Aorta

Penetrating atherosclerotic ulcer of the aorta is uncommon, and usually develops in the descending thoracic aorta. Rarely this condition involves the branch vessels of the aorta. We report a case of ruptured aneurysm of the innominate artery resulting from penetrating atherosclerotic ulcer. Open surgery was the treatment of choice for the ruptured aneurysm, while conservative treatment was recommended for the associated penetrating atherosclerotic ulcers of the descending aorta.

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