Quantitative Angiographic Hemodynamic Evaluation After Revascularization Surgery for Moyamoya Disease
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ORIGINAL ARTICLE
Quantitative Angiographic Hemodynamic Evaluation After Revascularization Surgery for Moyamoya Disease Yu Chen 1 & Li Ma 1 & Shuo Yang 2 & Jan-Karl Burkhardt 3 & Junlin Lu 1 & Xun Ye 1,4,5,6,7 & Weijian Jiang 2 & Zeguang Ren 8 & Rong Wang 1,4,5,6,9 & Xiaolin Chen 1,4,5,6 & Yuanli Zhao 1,4,5,6,7,9 Received: 1 July 2019 / Revised: 2 January 2020 / Accepted: 3 January 2020 # The Author(s) 2020
Abstract The corresponding hemodynamic changes of the internal carotid artery (ICA) after the revascularization surgery for moyamoya disease (MMD) remain unclear. The aim of this study was to analyze the hemodynamic changes of the ipsilateral ICA after the combined direct and indirect extracranial-intracranial (EC-IC) bypass. MMD patients undergoing combined EC-IC bypass were retrospectively reviewed. The mean transit time (MTT) of ICA was evaluated by color-coding angiography before revascularization and at follow-up. The MTT defined as the blood transit time between the end of cervical portion (C1) and the C7 segment of ICA. The clinical prognosis was assessed with Matsushima grading system, moyamoya vessel reduction system, and modified Rankin Scale (mRS). The correlation between hemodynamic parameter and prognosis was analyzed. Subgroup analysis was conducted between different presentations and different ages. Fifty-one patients were identified and the mean imaging follow-up interval was 5.5 months. The ICA-MTT was increased after the combined revascularization (P < 0.001) compared with contralateral ICA. Faster preoperative ICA-MTT was significantly associated with improved mRS in the ischemic group (P = 0.05). The increased ICA-MTT was significantly associated with favorable neoangiogenesis (P = 0.04), moyamoya vessel reduction (> 50%) (P = 0.023), and improved mRS score (P = 0.008). In subgroup analysis, the correlation in the ischemic subgroup and adult subgroup remained significant. In this cohort, the ICA-MTT increased after the combined EC-IC bypass, and there was a positive correlation between the increased blood transit time and favorable outcomes. Color-coding DSA proved to be useful as a quantitative and serial method to monitor postoperative courses after revascularization in MMD. Keywords Moyamoya disease . Combined bypass . Internal carotid artery . Hemodynamic change . Vessel remodeling
Introduction Moyamoya disease (MMD) is characterized by chronic, progressive stenosis, or occlusion of unknown causes that occurred in the distal internal carotid artery (ICA) and its branches, along with development of collateral vessels at the * Xiaolin Chen [email protected] 1
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
2
New Era Stroke Care and Research Institute, The Rocket Force General Hospital, Beijing, China
3
Department of Neurosurgery, Baylor College of Medicine Medical Center, Houston, TX, USA
4
China National Clinical Research Center for Neurological Diseases, Beijing, China
base of the brain [1]. The clinical onset of M
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