Letter to Quantitative Angiographic Hemodynamic Evaluation After Revascularization Surgery for Moyamoya Disease
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LETTER TO THE EDITOR
Letter to Quantitative Angiographic Hemodynamic Evaluation After Revascularization Surgery for Moyamoya Disease Jin Yu 1 & Miao Hu 1 & Jincao Chen 1 Received: 17 February 2020 / Revised: 17 February 2020 / Accepted: 5 March 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
directly focused on the hemodynamic changes of the responsible vessel rather than a large area of the brain. In addition, other evaluation criteria are also objective: to introduce Matsushima grading standard to evaluate the postoperative angiogenesis; to introduce moyamoya vascular reduction staging system to evaluate the degree of postoperative MMD vascular reduction. These provide the references for clinical research of MMD. There are still some points need to be noticed. For example, there are many other parameters in DSA perfusion, such as peak density value (PD), the area under the time—density curve (AUC) [4], which can be used to reflect a more comprehensive hemodynamic characteristic of the ICA in MMD. In present study, only MTT was used. More parameters can be added on this basis to fully explain the problem in MMD. Besides, the authors only selected ICA as the research object. In fact, the more direct target of revascularization is the cortical receptor vessel and corresponding ischemic areas. Using DSA perfusion to detect the hemodynamic changes of the more related vessels (such as MCA) that directly supply the ischemic area will be more meaningful. In this study, the authors speculated that the reason of the hemodynamic changes of ICA after operation may due to the decreased pressure between the beginning and the end segment of ICA, the decreased demand of ICA blood supply, and the increased perfusion from new collateral after revascularization. While the actual reason is not clear, we believe that comparing the changes of pre- and postoperative hemodynamics of MCA will be helpful to enrich the exploration of the causes.
Dear editor: We read with great interest the article by Chen et al. [1] regarding the quantitative angiographic hemodynamic evaluation after revascularization surgery for moyamoya disease (MMD). The authors analyzed the hemodynamic state in internal carotid artery (ICA) by digital subtraction angiography (DSA) perfusion and found an increased mean transit time (MTT) in ICA after the combined EC-IC bypass revascularization, which indicated a quantitative and serial method to monitor postoperative courses after revascularization in MMD. We really appreciate the interesting observation for their conclusion. Meanwhile, after reading this article, we would like to highlight 2 important questions that it raises. First, in this study, a new objective parameter (MTT) evaluated by DSA was used to value the changes of ICA hemodynamics in MMD patients and to reflect the improvement of hemodynamics in MMD patients by revascularization. Although DSA perfusion technology has been studied in other diseases, such as peripheral vascular disease [2], diabetes [3], and tumors [4]. However
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