Is STA really a low‐flow graft? A quantitative ultrasonographic study of the flow of STA for cerebral revascularization in MMD patients

SDF-1/CXCR4 axis participants in the pathophysiology of adult patients with moyamoya disease

BACKGROUND

Moyamoya disease (MMD) is characterized by an abundance of moyamoya vessels; however, the precise mechanism driving the spontaneous angiogenesis of these compensatory vessels remains unclear. Previous research has established a link between the stromal cell-derived factor-1 (SDF-1)/ CXC receptor 4 (CXCR4) axis and angiogenesis under hypoxic conditions. Nevertheless, the alterations in this axis within the cerebrospinal fluid, arachnoid membranes and vascular tissue of MMD patients have not been fully investigated.

METHODS

Our study enrolled 66 adult MMD patients and 61 patients with atherosclerotic vascular disease (ACVD). We investigated the SDF-1 concentration in cerebrospinal fluid (CSF) and CXCR4 expression level on the arachnoid membranes and vascular tissue. We utilized enzyme-linked immunosorbent assay and immunohistochemistr. Additionally, we cultured and stimulated human brain microvascular endothelial cells (HBMECs) and smooth muscle cells (SMCs) under oxygen and glucose deprivation (OGD) conditions followed by reoxygenation, to examine any changes in the SDF-1/CXCR4 axis.

RESULTS

The results demonstrated an elevation in the level of SDF-1 in CSF among MMD patients compared to those with ACVD. Moreover, the expression of CXCR4 in arachnoid membranes and vascular tissue showed a similar trend. Furthermore, the content of CXCR4 in HBMECs and SMCs increased with the duration of ischemia and hypoxia. However, it was observed that the expression of CXCR4 decreased at OGD/R 24h compared to OGD 24h. The temporal pattern of SDF-1 expression in HBMECs and SMCs mirrored that of CXCR4 expression.

CONCLUSION

These findings indicate a critical role for the SDF-1/CXCR4 axis in the angiogenesis of moyamoya disease.

Usefulness of STA ultrasonography parameters after STA-MCA bypass in patients with moyamoya disease: A short review

STA bypass assessment by ultrasonography after bypass surgery in patients with moyamoya disease is minimally invasive and can be performed repeatedly. With STA bypass assessment by ultrasonography, it was shown that in the short term, blood flow that passes through the STA peaks approximately 5 days after the bypass surgery and then gradually decreases over 7 days. In the medium and long terms, it has been shown that the blood flow through the bypass decreases, compared with that during the first postoperative week, and continues for approximately half a year. The ultrasonographic STA parameters can also clearly indicate bypass patency, but there remains some discussion regarding bypass function. Although some reports have tried to show that these parameters are also useful for predicting acute-phase TNEs and predicting the future of bypass function, no studies have yet examined these parameters in detail in relation to the state of cerebral circulation or degree of residual antegrade flow, and additional studies are needed in the future.