Efficacy of double anastomosis STA-MCA bypass in adult Moyamoya disease and cerebral atherosclerosis disease: a systematic review and meta-analysis.

Abstract

Double anastomosis Superficial Temporal Artery-Middle Cerebral Artery (STA-MCA) bypass in Moyamoya disease (MMD) and cerebral atherosclerosis disease (CAD) remains underexplored. We aim to evaluate the clinical efficacy and vascular dynamics of double anastomosis STA-MCA bypass in each group, MMD and CAD. A systematic search was conducted in ScienceDirect, Embase, PubMed, and Cochrane databases until September 2024. Efficacy outcomes included stroke occurrences, patency, modified Rankin Scale (mRS), and complications. Vascular parameters included cerebral blood flow (CBF), cut flow index (CFI), MCA perfusion, and mean transit time (MTT). The meta-analysis included 15 studies with 417 patients (46.18 ± 4.69 years). At final follow-up, the MMD group showed lower total stroke (12 ± 7% vs. 20 ± 9%; p = 0.63), ischemic stroke (8 ± 5% vs. 18 ± 8%; p = 0.26), hemorrhagic stroke (4 ± 3% vs. 10 ± 7%; p = 0.49), and patency (85 ± 11% vs. 98 ± 8%; p = 0.10) compared to CAD group, without statistical difference. The MMD group exhibited reduced mRS (MD: -0.57; 95%CI: -0.95 to -0.19; p = 0.003), increased CBF (MD: 14.75; 95%CI: 2.32 to 27.19; p = 0.020), and increased MCA perfusion (MD: 9.28; 95%CI: 1.19 to 17.37; p = 0.025). CFI (1.30 ± 0.11 vs. 1.08 ± 0.13; p = 0.02) and MTT (4.49 ± 0.5 vs. 1.27 ± 0.27; p < 0.001) were significantly higher in the CAD group. Both 1D2R (MD: 27.59; 95%CI: 4.88 to 50.30; p = 0.017) and 2D2R (MD: 14.75; 95%CI: 2.32 to 27.19; p = 0.020) techniques exhibited increase in CBF. Additionally, double anastomosis showed a higher CFI compared to single anastomosis (MD: 0.25; 95%CI: 0.12-0.38; p < 0.001). Double anastomosis STA-MCA bypass demonstrated comparable stroke and patency rates between groups. MMD patients had significantly higher CFI and MTT values, with double anastomosis yielding superior CFI compared to single anastomosis.