ИСТИНА

Moyamoya disease is a chronic disease with a complex pathophysiology, which has unique specific features of neoangiogenesis, both in the natural course of the disease and after surgical treatment, which are still largely unclear. Aim of the study was to determine the nature and degree of neoangiogenesis after combined revascularization and to identify the efficiency factors of its direct and indirect components. Methods: We analyzed 80 patients with Moyamoya disease who underwent 134 surgical interventions. The main group consisted of patients after combined revascularization (79 operations), 2 controls - after indirect (19) and direct (36) operations. Postoperative MRI images were studied, the function of each of the components of revascularization was evaluated based on angiographic and perfusion modes and their contribution to the overall result of revascularization, on the basis of which various degrees of their effectiveness were distinguished. Results: As a result of statistical analysis, it was found that the efficiency factors of the direct components of revascularization are the larger diameter of the acceptor (p=0.028) and donor (p<0.0001) arteries and the imposition of double bypasses (p=0.009). The efficiency factors of indirect synangiosis are the younger age of patients (p=0.009), the “ivy” sign on MRI (p=0.005), dilatation of the M4 branches of the MCA (p=0.026), the presence of transdural (p=0.004) and leptomeningeal (p=0.001) collaterals and the use of more indirect components (p=0.027). The best angiographic (p=0.023) and perfusion (p<0.0001) results of revascularization are achieved with the combined influence of direct and indirect components. If one of the components is ineffective, the other plays an insuring role in ensuring a good result of the operation. Conclusion: The preferred surgical method in patients with Moyamoya disease is combined revascularization, however, when planning surgical tactics, a differential approach should be followed, taking into account the effectiveness factors of various components of revascularization.