• World Neurosurg · Dec 2023

    Analysis of factors affecting good neovascularization after indirect bypass surgery: a two-center retrospective study.

    • Sang-Uk Kim, Joon Huh, Dal-Soo Kim, Choon-Woong Huh, Jae Hoon Sung, and Dong Hoon Lee.
    • Department of Neurosurgery, Myong-Ji St. Mary's Hospital, Seoul, South Korea.
    • World Neurosurg. 2023 Dec 1; 180: e99e107e99-e107.

    ObjectiveThe purpose of this study was to analyze factors affecting good neovascularization after indirect bypass surgery.MethodsFrom August 2000 to July 2020, postoperative image results and medical records of 132 patients (159 hemispheres) who underwent EDAS of indirect bypass surgery at two institutions were reviewed retrospectively. Based on DSA results, angiogenesis after indirect bypass was divided into "good" or "poor" according to the Matsushima criteria. STA flap length affecting GPN were analyzed in the entire group (n = 159) and a MMD group (n = 134).ResultsIn the entire group, GPN after EDAS was observed in 94 (59.1%) hemispheres. Age, MMD, hypertension, and bone flap size were identified as significant factors in univariate analysis. Also, in the MMD group, 86 (64.2%) hemispheres showed GPN. Hypertension and bone flap size were significant factors in both univariate and multivariate analyses. Cutoff values of bone flap size and GPN were 47.91 cm2 in the entire group and the MMD group.ConclusionsIn all patients who received EDAS, good postoperative neovascularization was significant in those with a young age, MMD, without hypertension, and large bone flap size. No hypertension and large bone flap size were meaningful factors in the MMD group. AUROC showed that an appropriate bone flap size was 47.91 cm2. However, a further controlled prospective study is needed.Copyright © 2023 Elsevier Inc. All rights reserved.

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