PMID- 26745491
OWN - NLM
STAT- MEDLINE
DCOM- 20180802
LR  - 20180802
IS  - 1933-0693 (Electronic)
IS  - 0022-3085 (Linking)
VI  - 125
IP  - 2
DP  - 2016 Aug
TI  - Surgical outcomes following encephaloduroarteriosynangiosis in adult moyamoya 
      disease associated with Type 2 diabetes.
PG  - 308-14
LID - 10.3171/2015.7.JNS15218 [doi]
AB  - OBJECTIVE Debate exists regarding the merits and shortcomings of an indirect 
      bypass procedure for treating adult patients with moyamoya disease (MMD). 
      Considerable variation in neovascularization occurs among different organs in 
      patients with diabetes mellitus. Here, the effect of 
      encephaloduroarteriosynangiosis on MMD associated with Type 2 diabetes mellitus 
      (T2DM) is evaluated. METHODS A retrospective and 1:2 matched case-control study 
      was conducted in moyamoya patients with or without T2DM (n = 180). Postoperative 
      collateral formations were graded according to the Modified Collateral Grading 
      System that originated from the Matsushima Angiographic Stage Classification. 
      Neurological function outcomes before and after the operation were evaluated 
      according to the modified Rankin Scale. Univariate and multivariate logistic 
      regression analyses were performed to determine the risk factors for clinical 
      outcome. RESULTS There was no statistically significant difference in the 
      constituent ratios of initial symptom and preoperative Suzuki stage between 
      patients with and without T2DM. Progression of angiopathy around the circle of 
      Willis was postoperatively observed in bilateral internal carotid arteries in 
      both groups. Patients with T2DM had a higher postoperative Suzuki stage (p < 
      0.01) and more frequent development of collateral angiogenesis germinating from 
      the external carotid after indirect revascularization procedures in the surgical 
      cerebral hemisphere (82.7% vs 72.2%; p < 0.05). The extent of postoperative 
      collateral formation in patients with diabetes mellitus was significantly higher 
      (p < 0.01). Postoperative clinical improvement in the diabetes group was more 
      common after revascularization procedures (p < 0.05), and the diabetes group had 
      lower modified Rankin Scale scores (p < 0.05) in comparison with the nondiabetes 
      group. Late postoperative stroke and posterior cerebral artery involvement were 
      identified as predictors of unfavorable clinical outcome in both groups, while 
      T2DM was associated with a favorable clinical outcome. CONCLUSIONS 
      Encephaloduroarteriosynangiosis is an efficacious treatment for adult patients 
      with MMD. Patients with T2DM could achieve better collateral circulation and 
      clinical improvement following surgery.
FAU - Ren, Bin
AU  - Ren B
AD  - Cardiovascular Drug Research Center, Institute of Health and Environmental 
      Medicine, Academy of Military Medical Sciences; and.
AD  - Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular 
      Disease; and.
FAU - Zhang, Zheng-Shan
AU  - Zhang ZS
AD  - Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular 
      Disease; and.
FAU - Liu, Wei-Wei
AU  - Liu WW
AD  - Consulting Centre of Biomedical Statistics, Academy of Military Medical Sciences, 
      Beijing, China.
FAU - Bao, Xiang-Yang
AU  - Bao XY
AD  - Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular 
      Disease; and.
FAU - Li, De-Sheng
AU  - Li DS
AD  - Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular 
      Disease; and.
FAU - Han, Cong
AU  - Han C
AD  - Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular 
      Disease; and.
FAU - Xian, Peng
AU  - Xian P
AD  - Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular 
      Disease; and.
FAU - Zhao, Feng
AU  - Zhao F
AD  - Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular 
      Disease; and.
FAU - Wang, Hui
AU  - Wang H
AD  - Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular 
      Disease; and.
FAU - Wang, Hai
AU  - Wang H
AD  - Cardiovascular Drug Research Center, Institute of Health and Environmental 
      Medicine, Academy of Military Medical Sciences; and.
FAU - Duan, Lian
AU  - Duan L
AD  - Department of Neurosurgery, 307th Hospital of PLA, Center for Cerebral Vascular 
      Disease; and.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20160108
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
SB  - IM
MH  - Adult
MH  - Case-Control Studies
MH  - Cerebral Revascularization/methods
MH  - Diabetes Mellitus, Type 2/*complications
MH  - Female
MH  - Humans
MH  - Male
MH  - Moyamoya Disease/*complications/*surgery
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Vascular Surgical Procedures/methods
OTO - NOTNLM
OT  - CBF = cerebral blood flow
OT  - DM = diabetes mellitus
OT  - EDAS = encephaloduroarteriosynangiosis
OT  - MCA = middle cerebral artery
OT  - MMD = moyamoya disease
OT  - PCA = posterior cerebral artery
OT  - STA = superficial temporal artery
OT  - T2DM = Type 2 DM
OT  - Type 2 diabetes
OT  - clinical outcome
OT  - collaterals
OT  - mRS = modified Rankin Scale
OT  - moyamoya disease
OT  - revascularization
OT  - vascular disorders
EDAT- 2016/01/09 06:00
MHDA- 2018/08/03 06:00
CRDT- 2016/01/09 06:00
PHST- 2016/01/09 06:00 [entrez]
PHST- 2016/01/09 06:00 [pubmed]
PHST- 2018/08/03 06:00 [medline]
AID - 10.3171/2015.7.JNS15218 [doi]
PST - ppublish
SO  - J Neurosurg. 2016 Aug;125(2):308-14. doi: 10.3171/2015.7.JNS15218. Epub 2016 Jan 
      8.