ИСТИНА

Background: Aim of the study was to assess the results of various methods of surgical revascularization in patients with MMD. Methods: Between 2008 to 2018 in BNI 64 patients with MMD were observed. Among them there were 14 adults (aged 19-37 years) and 50 children (aged 1,2-17). Male/female ratio was 1:1,8. The clinical manifestations included: transient ischemic attacks (74%), ischemic strokes (50%), epilepsy (24%), intracranial hemorrhage (8%), hyperkinesis (5%) and cephalgia (55%). Diagnostics were performed by DSA, MR-angiography and CT-angiography. Surgical treatment was performed in 13 adults (17 sides) and 33 children (52 sides). Total number of operations was 69. Indirect revascularization was performed in 12 patients (22 sides), direct revascularization was performed in 11 patients (15 sides), and combined revascularization was performed in 23 patients (32 sides). Indirect revascularization was performed only in children of younger age (up to 10 age). Direct revascularization was performed in 11 adults, 4 – bilateral revascularization. Combined revascularization was performed in 21 children (2 – 18 age) and 2 adults (19 and 35 age), 9 – bilateral revascularization. Follow-up period was up to 9 years. Results: In group of indirect revascularization improvement of the symptoms was seen in 77% of cases, in group of direct revascularization – in 91%, in group of combined revascularization there was the improvement in 100% of cases. The complications were seen more often in group of indirect revascularization and were associated with perioperative ischemic disorders (the overall percentage of complications was 5.8%, n = 4). Conclusions: Variant of the surgical revascularization should be chosen individually based on the age of the patient, clinical severity of the disease, angiographic characteristics of the donor and recipient vessels, state of collateral circulation and degree of cerebrovascular insufficiency with better results and a smaller percentage of perioperative complications observed in surgeries with direct component of revascularization.