Abstract T MP36: Indocyanine Green Videoangiography for Assessment of Postoperative Hyperperfusion in Moyamoya Disease

Abstract

Introduction: Postoperative cerebral hyperperfusion (HP) is a notable complication that occurs more frequently in moyamoya disease (MMD) than in atherosclerosis of unknown etiology. This study aimed to clarify the characteristics of intraoperative indocyanine green (ICG) videoangiography in MMD and atherosclerotic disease in terms of postoperative HP. Methods: This prospective study included 47 patients with 60 sides that underwent superior temporal artery (STA)-middle cerebral artery (MCA) single bypass. ICG videoangiography was performed after revascularization. The ICG time intensity curve was recorded in the STA, proximal MCA, distal MCA, and superficial Sylvian vein, and the angiographic differences among adult MMD, pediatric MMD, and atherosclerosis were analyzed. Results: Twenty two patients (27 sides) had adult MMD, 14 patients (22 sides) had pediatric MMD, and 11 patients (11 sides) had atherosclerosis. Postoperative HP was significantly higher in adult MMD (40.7%) than in pediatric MMD (18.2%) and atherosclerosis (0%). Adult MMD with HP was associated with a longer ICG peak time (P<0.001). There was no significant difference in ICG peak time among presentations in MMD, and no correlation between ICG peak time and preoperative hemodynamic parameters. The ratio of the vessel caliber was also higher in adult MMD with HP (P<0.001). Conclusions: ICG videoangiography provides different characteristics of bypass flow among adult MMD, pediatric MMD, and atherosclerosis. Poor distribution and run-off of blood flow from the STA might contribute to postoperative HP in MMD. The occurrence of postoperative HP in MMD could depend on two factors: host STA size and recipient MCA integrity.