The Treatment Of Cerebral Revascularization To Moyamoya Disease And Its Effect On Endothelial Progenitor Cells

Objective: To investigate the therapeutic effect of cerebral revascularization in the treatment of moyamoya disease and its effect on endothelial progenitor cells in vivo.Methods: Thirty-two patients with moyamoya disease underwent cerebral revascularization surgery,including 14 hemorrhagic patients and 18 ischemic patients.All patients were followed up for 3 months.CTA and brain magnetic perfusion imaging(3D-ASL)examinations were performed 1 day before the treatment and 3 months after the treatment,and disease outcome were get by a neurosurgeon chief physician and an imaging department chief physician.The clinical symptoms of each patient,the color change on the pseudo-color map,and the distribution of abnormal perfusion were analyzed comprehensively,and the regions of interest were delineated.Cerebral The relative parameter value drCBF is obtained by comparing the cerebral blood flow(rCBF)obtained from the region of interest with the cerebral blood flow in the contralateral mirror region.And postoperative drCBF were compared to investigate the imaging evidence of brain revascularization in improving cerebral perfusion.Neurological function scores were performed on all patients 1 day before surgery,1 week after surgery and 3 months after surgery by the modified Rankin Scale(mRs).Statistical comparisons were performed to investigate the neurological improvement of patients with moyamoya disease treated with cerebral blood flow reconstructive surgery.Blood samples were collected 1 day before the treatment and 3 months after the treatment.Mononuclear cells were isolated by density gradient centrifugation and labeled with three direct fluorescent antibodies,CD133,CD34,and VEGFR-2.Flow cytometric analysis was performed to get the content of endothelial progenitor cells.Results:1.The relative cerebral blood flow drCBF between the ischemic region and the contralateral mirror region after surgery was lower than the preoperative relative reference value,and there was statistically significant difference(P<0.05).2.The mRS score was significantly lower in the 1 day before surgery and 1 week after surgery compared with 3 months after surgery,and the difference was statistically significant(P<0.05).The mRS of postoperative one week decreased compared with the preoperative one day mRS,but the difference was not statistically significant(P>0.05).3.The content of endothelial progenitor cells in patients with circulating blood was significantly lower than that before surgery(P<0.05).Conclusions: Cerebral revascularization can significantly improve intracranial blood supply in patients with moyamoya disease,reduce the level of EPCs,and reduce smog angiogenesis,which may slow the progression of moyamoya disease and reduce the risk of cerebral infarction,epilepsy,transient ischemic attack and cerebral hemorrhage.Cerebral revascularization improve the nerve function and living ability of patient.