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Moyamoya.com Forum › Moyamoya Related Topics › Moyamoya Related Information and Support › Where does the "puff" go?

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Where does the "puff" go? (Read 4609 times)

lynn Junior Poster Offline I Love MM.com! Posts: 80 Michigan Gender:	Where does the "puff" go? Feb 28^th, 2011 at 10:33am I have been wondering about this and can't find any information about it. From what I understand, the puff of smoke blood vessels are dangerous because they are so small and weak and are prone to hemorrhage. After my son gets the surgery done and new vessels grow then what happens to those dangerous ones? Thanks.
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hrsridermom Senior Poster Offline mother of 19 yr old daughter with MMD Posts: 292 Tampa, USA, FL, Florida Gender:	Re: Where does the "puff" go? Reply #1 - Feb 28^th, 2011 at 8:55pm Lynn, I have always wondered the same thing and still don't have an answer. Maybe we'll get one soon.
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Lore

MM.com Benefactor

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My brother Kevin (Cubbie)
has Moyamoya

Posts: 819
Delaware, USA, usa, 419, 133, OH, Ohio
Gender: female

Re: Where does the "puff" go?
Reply #2 - Mar 4^th, 2011 at 1:56pm

Hi Lynn,

I'm not a doctor but in lay terms, this is how I understand the collateral vessels (puff of smoke).

Everyone has collateral vessels. The collateral vessels normally aren't open. However, with MM the collateral vessels grow and enlarge and therefore open to supply blood and oxygen due to the blockage in the artery. I also read that collateral vessels don't open in all people.

My understanding is that the collateral vessels are always present but they might not be open. So after by-pass surgery, the collateral vessels are still present but not necessarily open or functioning in terms of supplying blood and oxygen.

Lore

"What lies behind us and what lies before us are tiny matters compared to what lies within us." - Ralph Waldo Emerson

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Emily

Senior Poster

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Diagnosed Oct 2005. Direct
bypasses: Nov 05 Apr
06

Posts: 259
Brisbane, Australia
Gender: female

Re: Where does the "puff" go?
Reply #3 - May 2^nd, 2011 at 3:52am

I'm not a doctor either but I am currently studying nursing and plan to go on to medicine afterwards.

I agree with Lore, with a bit of an extension:

The danger with the collateral blood vessels is that when they open up due to the narrowing of the larger arteries, they create a detour around the narrow/blocked artery and can end up being the sole supply of blood and oxygen. Because they are so small compared to the volume of blood flow, they can be prone to hemorrhages.
After surgery, the new arteries (or blood vessels, depending on the nature of the bypass) are larger and stronger than these collateral vessels and more capable of delivering the required blood flow.

My understanding is that the collateral blood vessels would generally still remain open and just help out in getting all the blood to where it needs to go. Because they aren't the sole mode of transport, the risk of them hemorrhaging is significantly decreased.

I hope this helps a bit.

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mattsmom

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My son, Matthew, has moyamoya.

Posts: 59
Albuquerque, USA, usa, 180, 215, NM, New_Mexico
Gender: female

Re: Where does the "puff" go?
Reply #4 - May 3^rd, 2011 at 10:45am

Here is what I was told when my son had his surgery almost twelve years ago.

The "puff" vessels are caused because the major artery is closing. These puff vessels are dangerous because they are so small. The smallest clot can hit them (or the narrowed part of the major artery) and cause a stroke OR it can cause a bleed -- which is supposed to more common in adults.

If you look at the arteriogram, you will see that the "puff" vessels all form above the narrowing of the major artery. Once the major artery completely closes, the puff vessels will no longer receive blood. As a result, they wither and are no longer visible on an arteriogram. Basically, they deteriorate just as the top portion of the closed artery did.

Kim -- mom to Matthew, 19, 3 strokes at 7 due to moyamoya and single left kidney due to moyamoya causing renal artery stenosis

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