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Effects of Combined Remote Ischemic Pre-and Post-Conditioning on Neurologic Complications in Moyamoya Disease Patients Undergoing Superficial Temporal Artery-Middle Cerebral Artery Anastomosis

1
Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Gyeonggi-do 15355, Korea
2
Department of Anesthesiology and Pain Medicine, College of Medicine, Inha University Hospital, Incheon 22322, Korea
3
Department of Anesthesiology and Pain Medicine, Ajou university hospital, Suwon-si, Gyeonggi-do 16499, Korea
4
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
5
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
J. Clin. Med. 2019, 8(5), 638; https://doi.org/10.3390/jcm8050638
Received: 2 April 2019 / Revised: 7 May 2019 / Accepted: 7 May 2019 / Published: 9 May 2019
(This article belongs to the Section Anesthesiology)
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Abstract

Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is the most commonly used treatment for Moyamoya disease. During the perioperative period, however, these patients are vulnerable to ischemic injury or hyperperfusion syndrome. This study investigated the ability of combined remote ischemic pre-conditioning (RIPC) and remote ischemic post-conditioning (RIPostC) to reduce the occurrence of major neurologic complications in Moyamoya patients undergoing STA-MCA anastomosis. The 108 patients were randomly assigned to a RIPC with RIPostC group (n = 54) or a control group (n = 54). Patients in the RIPC with RIPostC group were treated with four cycles of 5-min ischemia and 5-min reperfusion before craniotomy and after STA-MCA anastomosis (RIPostC). The incidence of postoperative neurologic complications and the duration of hospital stay were determined. The overall incidence of neurologic complication was significantly higher in the control group than in the RIPC with RIPostC group (13 vs. 3, p = 0.013). The duration of hospital stay was significantly longer in the control group than in the RIPC with RIPostC group (17.8 (11.3) vs. 13.8 (5.9) days, p = 0.023). Combined remote ischemic pre- and post-conditioning can be effective in reducing neurologic complications and the duration of hospitalization in Moyamoya patients undergoing STA-MCA anastomosis. View Full-Text
Keywords: ischemic postconditioning; ischemic preconditioning; moyamoya disease; surgical anastomosis ischemic postconditioning; ischemic preconditioning; moyamoya disease; surgical anastomosis
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Choi, E.-S.; Lee, Y.-S.; Park, B.-S.; Kim, B.-G.; Sohn, H.-M.; Jeon, Y.-T. Effects of Combined Remote Ischemic Pre-and Post-Conditioning on Neurologic Complications in Moyamoya Disease Patients Undergoing Superficial Temporal Artery-Middle Cerebral Artery Anastomosis. J. Clin. Med. 2019, 8, 638.

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