Effects of Combined Remote Ischemic Pre-and Post-Conditioning on Neurologic Complications in Moyamoya Disease Patients Undergoing Superficial Temporal Artery-Middle Cerebral Artery Anastomosis.

Eun-Su Choi,Hye-Min Sohn,Yoon-Sook Lee,Young-Tae Jeon,Byeong-Seon Park,Byung-Gun Kim

doi:10.3390/jcm8050638

Abstract

Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is the most commonly used treatment for Moyamoya disease. During the perioperative period, however, these patients are vulnerable to ischemic injury or hyperperfusion syndrome. This study investigated the ability of combined remote ischemic pre-conditioning (RIPC) and remote ischemic post-conditioning (RIPostC) to reduce the occurrence of major neurologic complications in Moyamoya patients undergoing STA-MCA anastomosis. The 108 patients were randomly assigned to a RIPC with RIPostC group (n = 54) or a control group (n = 54). Patients in the RIPC with RIPostC group were treated with four cycles of 5-min ischemia and 5-min reperfusion before craniotomy and after STA-MCA anastomosis (RIPostC). The incidence of postoperative neurologic complications and the duration of hospital stay were determined. The overall incidence of neurologic complication was significantly higher in the control group than in the RIPC with RIPostC group (13 vs. 3, p = 0.013). The duration of hospital stay was significantly longer in the control group than in the RIPC with RIPostC group (17.8 (11.3) vs. 13.8 (5.9) days, p = 0.023). Combined remote ischemic pre- and post-conditioning can be effective in reducing neurologic complications and the duration of hospitalization in Moyamoya patients undergoing STA-MCA anastomosis.

Highlights

Moyamoya disease (MMD) involves the ends of the intracranial internal carotid arteries bilaterally, and is characterized by progressive stenosis of these vessels and the formation of thin and weak collateral blood vessels like puff of smoke
The aim of this study was to evaluate the effect of combined remote ischemic preconditioning (RIPC) and remote ischemic post-conditioning (RIPostC) on the incidence of neurologic complications in patients undergoing superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis
The 108 eligible patients were randomly assigned to the RIPC with RIPostC group or the control group using a computer-generated list: an anesthesia nurse not involved in the clinical care of the patients performed the study enrollment using a block randomization list generated by a computer-generated random number sequence

Summary

Introduction

Moyamoya disease (MMD) involves the ends of the intracranial internal carotid arteries bilaterally, and is characterized by progressive stenosis of these vessels and the formation of thin and weak collateral blood vessels like puff of smoke. Direct revascularization surgeries, such as superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis, are the most commonly used treatment for MMD [1,2,3]. RIPC reduces the recurrence of transient ischemic attack (TIA), improves resilience and increases cerebral perfusion in patients with a history of stroke or TIA, and in those with intracranial arterial stenosis [7]. Similar to RIPC, post-conditioning protects the heart and brain [9,10,11,12]

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