Hi!  My husband has had 2 angioplasty procedures to open the artery in the M1 & M2 areas of his brain - has is scheduled to go back in Sept. to see if it has collapsed again and if so, they will do another balloon procedure to open it back up.  His dr. thinks it may be a variant of MM - he has no know risk factors for this kind of narrowing.  We had a second opinion and they too feel like it is a variant of MM - not in the "normal" Circle of Willis area that is usually is - they recommend surgery.  Has anyone ever had angioplasty to open narrowing - his was 98% occlused. ??? anxious to hear - dpeck33@sbcglobal.net

:)
    Hi Toto,  I reciently asked my doctor, Dr. Connolly, ( a true moyamoya expert), why angioplasty is not used for moyamoya.  He nodded and said that it had reciently been used in japan with very good success thus far but that it is not yet considered a viable treatment in the U.S. It  sure seems like a natural snd less invasive treatment to me ::) but I'm sure that they have their reasons for not using it yet. ;)

Hi Toto....
...that was repeatly discussed for Cara but also repeatly feared unless done by surgeon with very skilled hands especially in kids....their arteries are tissue thin....as they kept saying what Cara had was something like MM for some time, too but didn't have all the classic MM symptoms yet.   Instead of using the word "antioplasty" they used the word "stent".  The neurosurgeon we saw said he knew of it done in adults but not in kids but he would look into it and get back to us.  Cara was about 4.5 at that time.   Her surgeries were done when she was 6.5....when another opinion said it would be risky to do the stent or maybe he said its past that stage.   So that stresses the importance of using a MM specialist that sees cases many times to recognize the variations of MM.   CarasMOM

When we returned to Stanford for our follow up after surgery,  the thought of angioplasty was brought up becauce the docs were still seeing the vessels narrowing.  After discussing this with Dr. Steinberg, he and the radiologist felt that angioplasty was to risky for moyamoya patients.  They didn't feel the vessels could go through that procedure and could rupture.  Just thought I would include this. Also this was back in Nov. 03, so maybe they feel differently now.  MichelleB

Thank you for your replies - the more you hear, the better.  The angioplasty is relatively new - and the dr. we use pioneered the procedure - he feels that it is better to keep the original vessel as long as possible.  Of course, this is also his specialty.  He is very conservative when opening the artery and has his followup visit within 2-3 months instead of 6-12 as most doctors have done with this procedure, not as successfully.  He said after you have the first angioplasty, scar tissue builds up and the second time it is done, the artery is stronger because of the scar tissue.  Also, he is opposed to using stents because our bodies don't like foreign objects in the brain - understandably!  He will use them as a last resort.  Dr. Steinberg believes that what my husband has is a variant of moyamoya and suggests surgery - how do you know what to do - it is hard to know what is right.  If anyone is would like an opinion about angioplasty, the doctor we used is wonderful!!!! He is very experienced in that arena.  Thanks for your comments and I'd be anxious to hear anymore!  

Wow, Toto...looks like you've got a lot of deep thinking to do regarding your husband's condition.  A few questions came to my mind which I'm sure you've probably asked yourself through all of this.....If your husband has the surgery that Dr. Steinberg is recommending, will it provide him a better/safer outcome than the angioplasty?  What are the risks between the surgery Dr. Steinberg is recommending and angioplasty?.... success rates of both?.... Would consulting other MM experts help you in making your decision?  Maybe that would be a good idea, that way you can see what the majority of MM experts recommend.

I, personally had a double bypass surgery, so speaking from my situation, the surgery was best suited for my situation (I had 2 direct and 1 indirect).  We briefly consulted with a local neuroradiologist here prior to my surgery and showed him my films, and he also "mentioned" angioplasty and the stent procedures, but it was not recommended in my case.  My neuro and neurosurgeon also agreed.

You've got little less than a month to decide unless you reschedule his appointment, which I'm not sure is a good idea either; however, continue to do what you're doing....research....stay strong....stay positive.....and always remember that we are not given anything we cannot handle.  Please continue to post any questions or concerns you may have....we're here for ya'!  ;)

Take care,
Shan

Hi All:

I guess I'm confused, as usual.  Brian's internal carotid arteries are totally gone now. He had surgeries STA-MCA 5 years ago this month. His angiograms before surgery were definative for advanced MM. Both of the carotids were seriously occluded. He could not have done angioplasty on the carotids. The research I have done on this disease states that it is a narrowing of the carotids. Are there, in fact, cases of moyamoya where the carotids are not involved?

..............Kathy

From my understanding, when you have a narrowed vessel that may not be in the carotid artery and there is no explanaiton for the narrowing that they call it a variation of mm.  The doctors we have spoken to say that is is "probably" a variation of MM, so how do you really know.  I think they are making the best diagnosis possible given the circumstances.  But this is why we are having such a hard time making a decision on what to do.  It is hard to get second opinions unless you fly around the country...many don't want to give opinions just seeing films, etc.  I wish they could create a billing for outside consultation, just like you were in the office.  They don't really need to se my husband, just the films of him.  Anyway, I'm rambling - so we will go see what has progressed or not next week and try to make a good decision.  Thanks for your comments!  

They're are neurosurgeons that will diagnose by just looking at the films...Dr. Steinberg and Dr. Scott in Boston I'm sure there are others I just persued those two. Thats how Mandy was diagnosed as needing surgery and confirmed her MM we just sent her films to Dr. Steinberg..........he did her surgerys. Good Luck!!
                           Nancy

katden wrote on Aug 4^th, 2005 at 10:51pm:

Hi All: I guess I'm confused, as usual.  Brian's internal carotid arteries are totally gone now. He had surgeries STA-MCA 5 years ago this month. His angiograms before surgery were definative for advanced MM. Both of the carotids were seriously occluded. He could not have done angioplasty on the carotids. The research I have done on this disease states that it is a narrowing of the carotids. Are there, in fact, cases of moyamoya where the carotids are not involved? ..............Kathy

Kathy,

The "M1" and "M2" areas toto was mentioning are branches of the Middle Cerebral Artery (MCA), which, of course, is the internal carotid artery.  Make sense?

You've met me so you know I'm not a doctor, but let me see if I can explain it using some drawings on the net:

Look at this diagram of the MCA: http://www.meddean.luc.edu/lumen/meded/Neuro/neurovasc/navigation/mca.htm

From my understanding, most MM appears near the bottom of that picture where the carotids come up from the neck and split, basically, what they call the "Circle of Willis".  Mine, specifically, showed up near the M1 and A1 segments.

By looking at these two drawings, you'll see both the M1 and A1 segments are both near the bottom, where everything brances out:

M1 segment - http://www.meddean.luc.edu/lumen/meded/Neuro/neurovasc/navigation/mcahor.htm

A1 segment - http://www.meddean.luc.edu/lumen/meded/Neuro/neurovasc/navigation/a1.htm

I would assume toto's husbands doctors are a little taken back by seeing evidence of "moyamoya type activity" way out in the M2 segment:  http://www.meddean.luc.edu/lumen/meded/Neuro/neurovasc/navigation/mcasyl.htm

Does any of this make any sense?  Is anyone still awake after reading all of this??  LOL

Did the drawings help anyone understand it better?

Deej

DJ wrote on Aug 27^th, 2005 at 10:44pm:

Did the drawings help anyone understand it better?

Great post Deej! Yep, they always help me. I think, it's always better when you see the drawings/diagrams. Then you begin to understand the circulatory system of the brain. MMD can seem complex enough, but in your post with the drawings, you can see the internal carotids have many twists and turns and that they branch out and join other arteries and so on & so on. We can better understand from the diagrams that there can be multiple occlusions of the cerebral circulation and where, and that MMD involves the circle of Willis and the arteries that feed it.

Thanks!

Mar