ИСТИНА

Objectives: The effect of surgical revascularization in patients with Moyamoya disease is based on postoperative collateral formation, however, the balance between direct and indirect revascularization is still to be determined. Background: To determine the efficiency factors of neoangiogenesis of direct and indirect components of revascularization, indications and tactics for their combined use. 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 control groups - after indirect (19) and direct (36) operations. Post- and intraoperative 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: Statistical analysis showed that the efficiency factors of the direct components of revascularization are the larger diameter o f 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 middle cerebral artery (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&lt;0.0001) results of revascularization are achieved with the combined influence of direct and indirect components. The use of intraoperative control, including the ioMR perfusion study, makes it possible to identify areas of residual hypoperfusion and determine indications for additional revascularization. Conclusions: Rational use of a combination of direct and indirect revascularization methods, taking into account the factors of their effectiveness and dynamic intraoperative perfusion data, allows achieving the targeted restoration of blood flow during surgical revascularization in patients with Moyamoya disease