Quantitative Angiographic Comparison With the OSIRIS Program Between the Direct and Indirect Revascularization Modalities in Adult Moyamoya Disease

BACKGROUND: Up-to-date, quantitative angiographic measurement of revascularization extent after bypass surgery has not been reported. OBJECTIVE: To measure the extent of angiographic revascularization quantitatively 6 months postoperatively with the OSIRIS program (University Hospital of Geneva, version 3.1). METHODS: A total of 75 bypass procedures were performed in 65 consecutive adult moyamoya disease patients, and 71 bypass surgeries in 61 adult moyamoya disease patients were studied 6 months postoperatively with angiography. We performed 5 different types of bypass surgeries: encephaloduroarteriosynangiosis (EDAS), superficial temporal artery-middle cerebral artery anastomosis (SMA), SMA with encephalomyosynangiosis (EMS), SMA with EDAS, and SMA with encephaloduroarteriomyosynangiosis (EDAMS). We also investigated single-photon emission computed tomography (SPECT) results after 6 months postoperatively and compared the angiographic revascularization extent with the SPECT results. RESULTS: The mean values for the extent of revascularization among 5 different bypass surgeries were as follows: 32.4% for EDAS only, 57.4% for SMA only, 58.4% for SMA with EMS, 66.1% for SMA with EDAS, and 70.8% for SMA with EDAMS. There was a statistically significant difference in the extent of revascularization among the 5 surgical modalities (P = .000) and between the EDAS-only group and various SMA groups (P = .000). Statistical analysis between angiographic revascularization extent and SPECT results demonstrated significant statistical correlation (P = .000). CONCLUSION: The extent of angiographic revascularization in adult moyamoya disease patients was highest in the SMA with EDAMS group and lowest in the EDAS-only group. In addition, angiographic revascularization extent was well correlated with the change in SPECT.