A Prospective Study on Hemodynamics of Combined Bypass Surgery in the Treatment of Moyamoya Disease

Objective: The study investigates the clinical effectiveness and prognosis of selecting recipient vessels for moyamoya disease (MMD) treatment during combined bypass surgery, focusing on hemodynamic criteria. Methods: Ninety-six MMD patients were randomly assigned to 3 groups (A, B, C) of 32 each, undergoing combined bypass surgery. Group A selected the vessel with the fastest fluorescing in the surgical field, group B the slowest, and group C used traditional methods. The authors monitored intraoperative recipient vessel pressure, cerebral blood flow (CBF), and modified Rankin scale (mRS) scores pre-surgery and post-surgery, and compared clinical symptom improvement, stroke recurrence, CBF, and mRS during a 6-month follow-up. Results: Postoperatively, groups A and B had significantly higher recipient vessel pressures than group C, with group B showing the highest ( P <0.05). CBF increased significantly in all groups at 7 days post-surgery and at 6 months, with groups A and B outperforming C, and group B showing the highest increase at 7 days ( P <0.05). mRS scores decreased significantly, with groups A and B showing lower scores than C at 6 months ( P <0.05). However, group B had a higher incidence of clinical symptoms post-surgery compared with A and C ( P <0.05). Conclusion: The study demonstrates that hemodynamic-based recipient vessel selection significantly improves clinical outcomes in MMD patients undergoing combined bypass surgery. Although group B showed the best hemodynamic results, it also had a higher incidence of immediate postoperative symptoms, suggesting a need for a balanced approach to optimize both short-term and long-term patient outcomes.