Abstract
In Moyamoya disease, cortical venous reddening (CVR) is occasionally observed immediately after direct revascularization and is thought to reflect an increase in cerebral blood flow. However, whether CVR is also observed in superficial temporal artery-middle cerebral artery anastomosis (STA-MCA bypass) for atherosclerotic steno-occlusive lesions has not been fully studied. We retro-spectively reviewed 29 patients who underwent STA-MCA bypass for symptomatic internal carotid artery, middle cerebral artery occlusion, or stenosis secondary to atherosclerosis at our institution between June 2019 and May 2023. Twenty-nine patients (21 males, median age 69 years) were divided into a CVR group (3 patients) and a non-CVR group (26 patients), and their backgrounds and outcomes were examined. No significant differences were observed in age, sex, atherosclerotic factors, cardiac disease, renal function, clinical presentation, bypass patency rate, or pre-and postoperative modified Rankin Scale scores between the two groups. The incidence of postoperative hyperperfusion syndrome (two patients [67%] in the CVR group and two patients [7.7%] in the non-CVR group, p=0.042) and cerebral infarction (three [100%] patients in the CVR group and one [3.8%] in the non-CVR group, p=0.001) was significantly higher in the CVR group. All patients in the CVR group had cerebral infarction in areas distant from the craniotomy field (remote infarction). However, none of the patients in the non-CVR group had remote infarction (3 [100%] in the CVR group and 0 [0%] in the non-CVR group, p<0.001). These results suggest a relationship between the occurrence of CVR and postoperative remote infarction after STA-MCA bypass for atherosclerotic lesions. In conclusion, the CVR may be an important predictor of remote infarction after STA-MCA bypass in atherosclerotic lesions.
