Revascularization procedure
Our protocol for screening, medical management, and surgical management
of patients with SCD and MMS has been described
previously.2 Indications for surgery include recent
stroke or transient ischemic attack (TIA) in the same distribution as
cerebral arterial stenosis with the presence of moyamoya collaterals.
Patients with remote or asymptomatic strokes generally undergo a
physiologic cerebral flow study, such as single-photon emission computed
tomography, followed by a similar study with acetazolamide. Following
the administration of acetazolamide, if an area of hypoperfusion is
found concordant with a stenosed cerebral artery, then revascularization
surgery is generally recommended. In general, indirect revascularization
procedures such as encephaloduro-arteriosynangiosis are performed;
occasionally, direct superficial temporal artery to middle cerebral
artery anastomosis has been performed, per surgeon’s preference.