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.

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

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

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!

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

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