The intraoperative hemodynamic and clinical research of three direct bypasses in moyamoya disease a prospective cohort of 98 cases

The goal of this study was to investigate clinical and hemodynamic differences in moyamoya disease patients underwent direct bypass using one donor-one recipient (1D1R), one donor-two recipients (1D2R), and two donors-two recipients (2D2R) bypass. To the authors' knowledge, this represents the largest series reported to date. Clinical and radiographic data were collected for 98 patients using 1D1R (28 cases), 1D2R (46 cases), and 2D2R (24 cases) bypasses. The patients' demographic information, clinical presentations, associated medical conditions, intraoperative hemodynamics, and postoperative hemispheric perfusion were obtained from reviewing medical records, intraoperative microvascular Doppler ultrasonography, and CT perfusion scans. There was no significant difference in the incidence of postoperative complication, bypass vessel patency, and good neovascularization among the 3 groups (P > 0.05). When postoperative complications occurred, patients in the 1D2R group had a lower modified Rankin Scale (mRS) score and a shorter duration of symptoms compared to those in the 1D1R group (P < 0.05). A significant difference was observed in the intraoperative mean velocity values of the donor vessel and the recipient artery (RA) in the parietal lobe among the three groups, with the 1D1R group showing the highest values (P < 0.05). Under blood pressure control, there was significant difference in the volumes of the hypoperfusion area, infarct core, and penumbra among the three groups (P < 0.05). The application of 1D1R, 1D2R, and 2D2R techniques resulted in distinct clinical and hemodynamic outcomes. Patients containing dual RAs were likely to have more extensive perfusion changes and better prognosis in the event of surgical complications.